A rare cause of bradycardia: non-conducted PJC's in bigeminy

Image 1 - Long lead II

This is best appreciated in a ladder diagram.

Image 2 Full disclosure and ladder diagram

The rhythm is sinus at a rate of about 50 bpm. Every other sinus beat is followed by an inverted (negative) P wave. This negative P wave is atrial activation from a premature junctional beat (in bigeminy). However, the PJC's are not conducted to the ventricles.

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