I'm definitely seeing P-Waves. However there are several different morphologies of them. I definitely think this is a strip that you need a lot more to come up with a good interpretation. But the big thing is, Is Your Patient symptomatic????? Treat the pt, not the monitor. I do not agree with the sick sinus syndrome, I was always told it was not something you could diagnose with a 3-Lead EKG. I thin kyou are looking at an SVT in the first part of the stip. There is definitely a different rhythem towards the end! Maybe a junctional rhythm. Definitely looks like PJC's though!