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Todd Schoonover is rehashing old avatars

review my Rhythm strips. (read all 14 entries…)
Wandering Atrial Pacemaker

Arrhythmia Recognition:
Rate: Less than 100 BPM
Regularity: Irregularly Irregular
P wave: Present
Morphology: Variable
Upright in II, III, aVF: Sometimes
P:QRS Ratio: 1:1
PR Interval: Variable
QRS Width: Normal or wide
Grouping: None
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.

Differential Diagnosis:
1. COPD
2. Respiratory Failure
3. Atrial Enlargement
4. Electrolyte abnormalities
5. Drugs: nicotine, alcohol, caffeine, etc.



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