Skip to Main Content
Home Books Quick Dx & Rx: Cardiology

Wandering Atrial Pacemaker

KEY FEATURES

ESSENTIALS OF DIAGNOSIS

  • Progressive cyclic variation in P-wave morphology

  • Heart rate 60–100 bpm

  • Variation of P-wave morphology, P-P interval, and P-R interval

GENERAL CONSIDERATIONS

  • This rhythm is benign

  • This rhythm and multifocal atrial tachycardia are similar except for heart rate

  • The other possible explanation is that there is significant respiratory sinus arrhythmia, with uncovering of latent foci of pacemaker activity

  • Usually, it is associated with underlying lung disease

  • In the elderly, it may be a manifestation of sick sinus syndrome

  • In the young and athletic heart, it may represent enhanced vagal tone

CLINICAL PRESENTATION

SYMPTOMS AND SIGNS

  • Usually causes no symptoms and is incidentally discovered

  • Occasional patient may feel skipped beats

PHYSICAL EXAM FINDINGS

  • Variable S1

DIFFERENTIAL DIAGNOSIS

  • Multifocal atrial tachycardia (heart rate > 100 bpm)

  • Frequent premature atrial complexes and atrial bigeminy

DIAGNOSTIC EVALUATION

LABORATORY TESTS

  • None specific

ELECTROCARDIOGRAPHY

  • ECG to document rhythm

TREATMENT

CARDIOLOGY REFERRAL

  • Not required

MEDICATIONS

  • No specific treatment

  • Monitor and treat the underlying cause, such as sick sinus syndrome or lung disease

DIET AND ACTIVITY

  • No restrictions

  • General healthy lifestyle

ONGOING MANAGEMENT

FOLLOW-UP

  • Once a year if sinus node abnormality is suspected; otherwise when symptoms arise

COMPLICATIONS

  • May progress to sick sinus syndrome

PROGNOSIS

  • This condition by itself is benign

RESOURCES

PRACTICE GUIDELINES

  • Indications for pacemaker:

    • – If part of sick sinus syndrome

    • – If associated with documented symptomatic bradycardia

REFERENCES

+
+
Page  RL, Joglar  JA, Caldwell  MA,  et al. 2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation. 2016;133:e506.  [PubMed: 26399663]

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.

This site uses cookies to provide, maintain and improve your experience. MHE Privacy Center Close