Diagnostic criteria


  The impulses originate not only from the sinus rhythm but also from different ectopic atrial foci.

      Therefore, there are P waves with
at least 3 different configurations.

  The impulses originate not only from the sinus rhythm but also from different ectopic atrial foci.

      Therefore PP, PR and RR
intervals vary.

  Each P wave is followed by a QRS complex.

  The QRS complexes are narrow (<120msec) since the impulse originates from the atria.

  The heart rate is between
60-100/minute and irregular.

  Generally seen under
increased vagal tone.





ECG 1. Wandering atrial pacemaker is seen on the Holter tracing above. The
P waves have at least 3 different configurations

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ECG 2. Wandering atrial pacemaker in a patient with chronic obstructive lung disease.
P waves have different shapes.

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ECG 3. Wandering atrial pacemaker. There are
P waves with at least 3 different configurations .

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ECG 4. Wandering atrial pacemaker in another patient.

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ECG 5. The ECG above belongs to a 65 years-old hypertensive woman.
P waves with at least 3 different shapes suggest
"
wandering atrial pacemaker . In addition, there is also left ventricular hypertrophy pattern according to the Cornell voltage
and Gubner criteria.

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ECG 6. Wandering atrial pacemaker (P waves with at least 3 different shapes). The above ECG belongs to an 11 years-old boy.

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ECG 7a. The ECG above belongs to an old man with COPD and coronary artery disease.
P waves with at least 3 different shapes suggest wandering atrial pacemaker.

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ECG 7b. The ECG above belongs to the same patient.
P waves with at least 3 different shapes suggest wandering atrial pacemaker.

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ECG 8a. The above ECG is from a 25 years-old woman with no structural heart disease (normal ECHOcardiography).
At a calibration of 20 mm/mV, this ECG shows P waves with at least 3 different configurations: wandering atrial pacemaker.

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ECG 8b. The ECG above belongs to the same woman. It was recorded 4 months after recording of the ECG 8a.
P waves with at least 3 different shapes are difficult to recognize at a calibration of 10 mm/mV.

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ECG 8c. The ECG above belongs to the same woman.
It was recorded immediately after the ECG 8b, but at a calibration of 20 mm/mV.
Now, P waves with at least 3 different shapes are clearly seen: wandering atrial pacemaker.
Recording of the ECGs at a calibration of 20 mm/mV is important for the diagnosis of wandering atrial pacemaker.

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