Lead II is frequently unrepresentative of QRS configurations, especially for arrhythmias. Here, there is atrial bigeminy due to premature atrial complexes. Although the last QRS in lead II is ...

A junctional rhythm occurs when the electrical activation ... which is normally upright in lead II and biphasic in lead V1. Often, the P wave is inverted in lead II, if it can be seen at all.

Now, look at the rhythm strip at the bottom in lead V1 to see the AV dissociation. This ECG also meets the Brugada Criteria for concordance. In this LBBB pattern, all the QRS complexes are ...