Todd Schoonover is going undercover
Rate: Less than 100 BPM
Regularity: Irregularly Irregular
P wave: Present
Upright in II, III, aVF: Sometimes
P:QRS Ratio: 1:1
PR Interval: Variable
QRS Width: Normal or wide
Dropped Beats: Sometimes
Note: A wandering atrial pacemaker is an irregularly irregular rhythm with a ventricular rate less than 100 BPM, characterized by at least three different P-wave morphologies on the same strip, each associated with their own PR interval. Contrary to a tracing with frequent PACs, there’s no underlying regular rhythm associated with it.
Strip: This ECG strip shows the classic changes of a wandering atrial pacemaker. Notice the slow, gradual transition of the P waves from upright to inverted. Longer strips show the transition occurring back and forth between the pacemakers. Notice that the QRS complexes and T waves are identical in this strip. There is no evidence of any aberrant conduction, as can sometimes occur with faster rates.
2. Respiratory Failure
3. Atrial Enlargement
4. Electrolyte abnormalities
5. Drugs: nicotine, alcohol, caffeine, etc.