Retrograde Wenckebach

Sinus rhythm with concealed intranodal reentry and an episode of accelerated junctional rhythm with retrograde Wenckebach

Edit: (092823)

I would like to thank Dr. @NaokiThukishima who was able to point-out that after R4 is a PAC and not a retrograde P wave. Thus this arrhythmia was initiated by PAC leading to AVNRT. Dr. @AThomazAndrade also suggested that this could be AVNRT with a Wenckebach. Thus, the proposed ladder diagram is shown below (top diagram).

References:

Fisch C and Knoebel SB. 2000. Electrocardiography of Clinical Arrhythmia. New York. Futura Publishing Co.

Wang K.2013. Altas of Electrocardiography. India Jaypee Bros

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