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==Overview==
==Overview==
                      
                      
This atrial arrhythmia occurs when the natural cardiac pacemaker site shifts between the SA node, the atria, and/or the AV node. This shifting of the pacemaker from the SA node to adjacent tissues is manifested electrocardiographically by transient changes in the size shape and direction of the P waves.
This atrial arrhythmia occurs when the natural cardiac pacemaker site shifts between the [[SA node]], the [[atria]], and/or the [[AV node]]. This shifting of the pacemaker from the SA node to adjacent tissues is manifested electrocardiographically by transient changes in the size shape and direction of the [[P waves]].
A wandering pacemaker is usually caused by varying vagal tone. With increased vagal tone the SA Node slows,allowing a pacemaker in the atria or AV Nodal area,which may become slightly faster briefly. After vagal tone decreases the SA Node becomes the pacemaker again.
A wandering pacemaker is usually caused by varying vagal tone. With increased vagal tone the SA node slows,allowing a pacemaker in the atria or AV Nodal area,which may become slightly faster briefly. After vagal tone decreases the SA node becomes the pacemaker again.Note that if the heart rate increases to above 100bpm, it is called [[multifocal atrial tachycardia]]. Possible causes are [[hypoxia]], [[COPD]] and medication such as [[digoxin]].


==EKG examples==
==EKG Examples==
Shown below is an EKG image of a wandering atrial pacemaker. When several [[pacemaker]]s are competing, [[p-waves]] with different origins and thus configurations occur. The [[rhythm]] is slightly different from beat to beat.
[[File:Wandering_Atrial_Pacemaker_1.png|500px|center]]
Copyleft image obtained courtesy of ECGpedia, http://en.ecgpedia.org/wiki/Main_Page


[[Image:Rhythm WAP.png|thumb|250px|left|Wandering pacemaker. Every p-wave is different and thus has a different origin.]]
==References==
[[Image:Rhythm WAP.png|thumb|left]]
{{Reflist|2}}


==Additional resources==
{{Electrocardiography}}
 
* [http://en.ecgpedia.org ECGpedia: Course for interpretation of ECG]
* [http://www.anaesthetist.com/icu/organs/heart/ecg/ The whole ECG - A basic ECG primer]
* [http://www.ecglibrary.com 12-lead ECG library]
* [http://www.ecgsim.org Simulation tool to demonstrate and study the relation between the electric activity of the heart and the ECG]
* [http://heartcenter.seattlechildrens.org/what_to_expect/electrocardiogram.asp ECG information from Children's Hospital Heart Center, Seattle]
* [http://www.regionalpci-stemi.org/id10.html ECG Challenge from the ACC D2B Initiative]
* [http://0-www.nhlbi.nih.gov.innopac.up.ac.za:80/health/dci/Diseases/ekg/ekg_what.html National Heart, Lung, and Blood Institute, Diseases and Conditions Index]
* [http://www.ecglibrary.com/ecghist.html A history of electrocardiography]
* [http://www.health.gov.mt/impaedcard/issue/issue1/ipc00103.htm EKG Interpretations in infants and children]
* [http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/cardiology/atrial-fibrillation/ Atrial Fibrillation Management] Cleveland Clinic


{{Electrocardiography}}
{{SIB}}
[[Category:Electrophysiology]]
[[Category:Electrophysiology]]
[[Category:Cardiology]]
[[Category:Cardiology]]
[[Category:Arrhythmia]]


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Latest revision as of 21:24, 20 August 2013

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Overview

This atrial arrhythmia occurs when the natural cardiac pacemaker site shifts between the SA node, the atria, and/or the AV node. This shifting of the pacemaker from the SA node to adjacent tissues is manifested electrocardiographically by transient changes in the size shape and direction of the P waves. A wandering pacemaker is usually caused by varying vagal tone. With increased vagal tone the SA node slows,allowing a pacemaker in the atria or AV Nodal area,which may become slightly faster briefly. After vagal tone decreases the SA node becomes the pacemaker again.Note that if the heart rate increases to above 100bpm, it is called multifocal atrial tachycardia. Possible causes are hypoxia, COPD and medication such as digoxin.

EKG Examples

Shown below is an EKG image of a wandering atrial pacemaker. When several pacemakers are competing, p-waves with different origins and thus configurations occur. The rhythm is slightly different from beat to beat.

Copyleft image obtained courtesy of ECGpedia, http://en.ecgpedia.org/wiki/Main_Page

References


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