Junctional escape rhythm - ECG interpretation made easy for nursing students, nursing school, NCLEX, and nurses.
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Junctional escape rhythms occur because the SA node (sinoatrial node) is not working properly. As a result, other pacemaker structures in the AV junction begin taking over.

With junctional escape rhythms, you notice that the rate is 40-60 bpm and regular. QRS will be narrow (less than 0.12 seconds), QT interval and T wave will be normal.

However, the P wave can have unique characteristics. It can be inverted on aVF, II, and III. It can also be concealed within the QRS, or even after the QRS.

Animation credit: Alila_Medical_Images/pond5

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