Electrocardiographic manifestations of concealed junctional ectopic impulses

Thirteen episodes of concealed junctional ectopic impulses (JEI) in ten patients are described. In nine patients the JEI manifested as isolated automatic impulses and in one as a parasystolic junctional tachycardia. In addition to the previously described unexpected prolongation of the P-R, Type I and Type II A-V block, the following phenomena were recorded: 1) marked, greater than 400 msec, and persistent prolongation of the P-R interval, 2) striking changes in the duration of the P-R with an occasional sequence of R-P and P-r intervals simulating "supernormal" A-V conduction, 3) unexpected variation of the junctional escape interval explained by junctional parasystole with entrance block, 4) postponed compensatory pause, 5) concealed junctional discharge with reciprocation.