Wandering atrial pacemaker: Difference between revisions
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*Rate is less than 100bpm (in contrast to [[MAT]]) | *Rate is less than 100bpm (in contrast to [[MAT]]) | ||
*Is irregularly irregular therefore sometimes confused with [[atrial fibrillation]] and sinus arrhythmia | *Is irregularly irregular therefore sometimes confused with [[atrial fibrillation]] and sinus arrhythmia | ||
===Causes=== | |||
* Intrinsic cardiac or pulmonary disease | |||
* Metabolic derangements | |||
* Drug toxicity (including [[Digoxin toxicity|Digoxin]]) | |||
==Clinical Features== | ==Clinical Features== | ||
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==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Palpitations DDX}} | {{Palpitations DDX}} | ||
Latest revision as of 21:52, 31 August 2022
Background
- Three or more ectopic foci within the atrial myocardium serve as the pacemaker
- Rate is less than 100bpm (in contrast to MAT)
- Is irregularly irregular therefore sometimes confused with atrial fibrillation and sinus arrhythmia
Causes
- Intrinsic cardiac or pulmonary disease
- Metabolic derangements
- Drug toxicity (including Digoxin)
Clinical Features
- Often seen in the extremes of age and in athletes
- Rarely causes symptoms
Differential Diagnosis
Palpitations
- Arrhythmias:
- Non-arrhythmic cardiac causes:
- Psychiatric causes:
- Drugs and Medications:
- Alcohol
- Caffeine
- Drugs of abuse (e.g. cocaine)
- Medications (e.g. digoxin, theophylline)
- Tobacco
- Misc
Evaluation
Workup
Diagnosis
- ECG should show three distinct P wave morphologies with a ventricular rate <100bpm
Management
- Rarely requires treatment
Disposition
- Outpatient management