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Failure to Capture and Sense  example one

After eight ventricularly paced beats, the pacer fails to capture with its ninth impulse.  A native beat, probably junctional, follows and is not sensed, and then another unsensed native beat occurs.  The next pacer spike, falling just before a native beat, fails to capture.  Coming just before a native beat it probably should have produced a fusion beat.  This beat is also not sensed, and the next pacer spike fails to capture.  Note the P-waves that may be seen marching through the strip.  The underlying rhythm here may be junctional escape from third degree block.