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ECG Findings

  • Bradycardia, typically with a rate of 20 to 40 bpm.

  • The QRS complex is wider than 120 ms.

  • Can have LBBB or RBBB morphology.


  1. When the atria and the AV node fail to initiate a cardiac rhythm, or when no pacing signal reaches the ventricle, the ventricular tissue usually picks up the pacemaking responsibility.

  2. P waves may also be conducted retrograde and buried in the T wave.


Ventricular Rhythm with Retrograde P Waves. (ECG contributor: James V. Ritchie, MD.)


Wide-complex (double arrow) regular QRS at a rate of approximately 50 bpm. Retrograde P waves are seen in this example (arrow).

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