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Wandering Atrial Pacemaker
Diagnostic criteria
The impulses originate not only from the sinus rhythm but also from different ectopic atrial foci. Therefore, there are P waves with at least 3 different configurations.
The impulses originate not only from the sinus node but also from different ectopic atrial foci. Therefore PP, PR and RR intervals vary.
Each P wave is followed by a QRS complex.
QRS complexes are narrow (< 120 msec) since the impulses originate from the atria.
The heart rate is between 60-100/minute and irregular.
Generally seen under increased vagal tone.
ECG 1. Wandering atrial pacemaker is seen on the Holter tracing above. The P waves have at least 3 different configurations
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ECG 2. Wandering atrial pacemaker in a patient with chronic obstructive lung disease. P waves have different shapes.
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ECG 3. Wandering atrial pacemaker. There are P waves with at least 3 different configurations .
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ECG 4. Wandering atrial pacemaker in another patient.
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ECG 5. The ECG above belongs to a 65 years-old hypertensive woman. P waves with at least 3 different shapes suggest
"wandering atrial pacemaker . In addition, there is also left ventricular hypertrophy pattern according to the Cornell voltage
and Gubner criteria.
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ECG 6. Wandering atrial pacemaker (P waves with at least 3 different shapes). The above ECG belongs to an 11 years-old boy.
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ECG 7a. The ECG above belongs to an old man with COPD and coronary artery disease.
P waves with at least 3 different shapes suggest wandering atrial pacemaker.
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ECG 7b. The ECG above belongs to the same patient.
P waves with at least 3 different shapes suggest wandering atrial pacemaker.
Click here for a more detailed ECG
ECG 8a. The above ECG is from a 25 years-old woman with no structural heart disease (normal ECHOcardiography).
At a calibration of 20 mm/mV, this ECG shows P waves with at least 3 different configurations: wandering atrial pacemaker.
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ECG 8b. The ECG above belongs to the same woman. It was recorded 4 months after recording of the ECG 8a.
P waves with at least 3 different shapes are difficult to recognize at a calibration of 10 mm/mV.
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ECG 8c. The ECG above belongs to the same woman.
It was recorded immediately after the ECG 8b, but at a calibration of 20 mm/mV.
Now, P waves with at least 3 different shapes are clearly seen: wandering atrial pacemaker.
Recording of the ECGs at a calibration of 20 mm/mV is important for the diagnosis of wandering atrial pacemaker.
Click here for a more detailed ECG
The impulses originate not only from the sinus rhythm but also from different ectopic atrial foci. Therefore, there are P waves with at least 3 different configurations.
The impulses originate not only from the sinus node but also from different ectopic atrial foci. Therefore PP, PR and RR intervals vary.
Each P wave is followed by a QRS complex.
QRS complexes are narrow (< 120 msec) since the impulses originate from the atria.
The heart rate is between 60-100/minute and irregular.
Generally seen under increased vagal tone.
ECG 1. Wandering atrial pacemaker is seen on the Holter tracing above. The P waves have at least 3 different configurations
Click here for a more detailed ECG
ECG 2. Wandering atrial pacemaker in a patient with chronic obstructive lung disease. P waves have different shapes.
Click here for a more detailed ECG
ECG 3. Wandering atrial pacemaker. There are P waves with at least 3 different configurations .
Click here for a more detailed ECG
ECG 4. Wandering atrial pacemaker in another patient.
Click here for a more detailed ECG
ECG 5. The ECG above belongs to a 65 years-old hypertensive woman. P waves with at least 3 different shapes suggest
"wandering atrial pacemaker . In addition, there is also left ventricular hypertrophy pattern according to the Cornell voltage
and Gubner criteria.
Click here for a more detailed ECG
ECG 6. Wandering atrial pacemaker (P waves with at least 3 different shapes). The above ECG belongs to an 11 years-old boy.
Click here for a more detailed ECG
ECG 7a. The ECG above belongs to an old man with COPD and coronary artery disease.
P waves with at least 3 different shapes suggest wandering atrial pacemaker.
Click here for a more detailed ECG
ECG 7b. The ECG above belongs to the same patient.
P waves with at least 3 different shapes suggest wandering atrial pacemaker.
Click here for a more detailed ECG
ECG 8a. The above ECG is from a 25 years-old woman with no structural heart disease (normal ECHOcardiography).
At a calibration of 20 mm/mV, this ECG shows P waves with at least 3 different configurations: wandering atrial pacemaker.
Click here for a more detailed ECG
ECG 8b. The ECG above belongs to the same woman. It was recorded 4 months after recording of the ECG 8a.
P waves with at least 3 different shapes are difficult to recognize at a calibration of 10 mm/mV.
Click here for a more detailed ECG
ECG 8c. The ECG above belongs to the same woman.
It was recorded immediately after the ECG 8b, but at a calibration of 20 mm/mV.
Now, P waves with at least 3 different shapes are clearly seen: wandering atrial pacemaker.
Recording of the ECGs at a calibration of 20 mm/mV is important for the diagnosis of wandering atrial pacemaker.
Click here for a more detailed ECG