Wandering atrial pacemaker

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

Clinical Features

• Often seen in the extremes of age and in athletes
• Rarely causes symptoms

Differential Diagnosis

• Intrinsic cardiac or pulmonary disease
• Metabolic derangements
• Drug toxicity (including Digoxin)

Evaluation

Workup

• ECG

Diagnosis

• ECG should show three distinct P wave morphologies with a ventricular rate <100bpm

Management

• Rarely requires treatment

Disposition

• Outpatient management

See Also

• Multifocal atrial tachycardia
• Dysrhythmia