Wandering atrial pacemaker



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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.

Additional resources

 * ECGpedia: Course for interpretation of ECG
 * The whole ECG - A basic ECG primer
 * 12-lead ECG library
 * Simulation tool to demonstrate and study the relation between the electric activity of the heart and the ECG
 * ECG information from Children's Hospital Heart Center, Seattle
 * ECG Challenge from the ACC D2B Initiative
 * National Heart, Lung, and Blood Institute, Diseases and Conditions Index
 * A history of electrocardiography
 * EKG Interpretations in infants and children
 * Atrial Fibrillation Management Cleveland Clinic