An extra P wave that is not followed by a QRS complex can be caused by a conduction block (i.e. AV block), or by an arrhythmia such as Atrial Flutter.
See also: P wave
Can you add to the information on this page?
This ECG Archive is an academic, non-commercial #FOAMed project aiming to crowdsource a free open access database of ECGs and signs. If you include your personal details such as your name you will be attributed for your contribution, unless you tell us that you don't want this to happen. Personal contact details such as email addresses will not be published but may be used to email you in reply. Full project details and participant information available here.
What will you do for this altered and bradycardic patient?