Sinus Rhythm

ECG Recognition:

It is recognized by the P wave morphology that is:

• upright P in leads I, II and aVF
• inverted in aVR
• variable in leads III and aVL
• upright in leads V4-V6 (in 12-lead ECG)
• most often biphasic (positive-negative) in leads V1 and V2
• with minor variations in morphology related to respiratory cycle

Can be followed by a narrow or wide QRS.
May not be followed by a QRS in cases of AV dissociation.
Sinus bradycardia if the rate is less than 60 bpm.
Sinus tachycardia if the rate is more than 100 bpm.

Normal Sinus Rhythm 

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