This results in an inverted P wave in lead II (normally upright in sinus rhythm) and an upright P wave in aVR (normally inverted in sinus rhythm). Depending on the exact location of the pacemaker ...

The atrial rate is approximately 160 beats per minute (bpm) with inverted P waves in II-III-AVF. The narrow ventricular complexes are regular at 80 bpm, with 2:1 atrioventricular (AV) block.