This is a good example of an AV Sequential pacemaker in a patient with an intact AV conduction system. The pacemaker is pacing the right atrium, and the impulse is being transmitted normally down through the AV node and the interventricular conduction system.
This is a good teaching ECG for beginners just learning to recognize paced rhythms. Spikes are not always this easy to see! All the characteristics of pacing are here, including spikes, of course. There are wide QRS complexes, indicating only one ventricle is being paced. The impulse spreads slowly from the right ventricle to the left. The axis is leftward because the left ventricle is being paced from the right ventricle, which is located down near the diaphragm. The rate is typical of a paced rhythm.
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