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

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

Evaluation

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Workup

Diagnosis

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

Management

  • Rarely requires treatment

Disposition

  • Outpatient management

See Also

External Links

References