Total Eclipse of the Heart

ANSWER

The correct interpretation includes sinus rhythm with complete heart block and a junctional rhythm. Normal sinus rhythm is evidenced by normal-appearing P waves at a rate of about 66 beats/min, although there is some respiratory variation. There is no correlation of the P waves to the QRS complex. A junctional rhythm is diagnosed based on narrow QRS complexes of normal duration (82 ms). The patient underwent implantation of a dual-chamber pacemaker and had a complete recovery.