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
Diagnosis
- ECG should show three distinct P wave morphologies with a ventricular rate <100bpm
Management
- Rarely requires treatment
Disposition
- Outpatient management