Wandering atrial Pacemaker

ECG Findings:

• Variable amplitude and/or morphology of the P wave
• The change in P wave amplitude and/or morphology tends to gradually shift from normalcy
• It occurs in association with sinus arrhythmia

Etiology:

• Associated with increased vagal tone
• Due to shifting of the point of origin of depolarization within the complex sino-atrial node structure
• Usually a normal finding

Consequences:

• None
• In the face of a marked sinus arrhythmia, altered P wave morphology may be misinterpreted as atrial premature beats

Treatment: None required