Small, negative, regular P waves are present, indicating an ectopic low atrial pacemaker at 60/minute.
They are in competition with and accelerated junctional focus whose rate is 75/minute.
The result is AV dissociation due to usurping junctional pacemaker.
The four capture beats -(C)- indicate that the AV bride is intact.
There is also Right Axis Deviation probably due to Left Posterior Fascicular Block (LPFB).