DESCRIPTION

A sort of poetic description, suggestive of a thoughtful atrial pacemaker, pipe in hand, strolling around the campus, perhaps bumping into an occasional tree. Actually, the label suggests that the cells that are discharging within the atrium and driving the rhythm are indeed not always in the same place, particularly not in the sinus node. How can we tell? We just look at the P waves, and if we see various shaped P waves (see arrows) often with different PR intervals, we infer each beat originates from a different spot in the atrium and activates the atrium in a different direction – hence the actual pacemaker is “wandering.”

HABITAT

Usually in quiet, non-stressed situations, such as … odd, I can’t think of any! Maybe eating cheesecake after a family gathering, if the noisy cousin isn’t there.

CALL

“Yawn … anything else for dessert?”

RESEMBLANCE TO OTHER ARRHYTHMIAS

The variable R–R intervals might be mistaken for atrial fibrillation if you don’t look closely for P waves. You might also be tempted to call beats which were a little early with different P waves premature atrial complexes. This could lead to some further pointless arguments, since here as well as in the sinus arrhythmia debates (above) there is absolutely no impact on therapies (none) or outcome (uniformly good). The presence of multiple (at least three) P morphologies and the lack of a repetitive pattern (which might be more suggestive of premature atrial complexes) would lead you to call this a wandering atrial pacemaker.

CARE AND FEEDING

There’s really nothing much to do. Make sure the oxygen saturation is alright, and then go get the cheesecake.

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