Wandering Atrial Pacemaker

A wandering atrial pacemaker (WAP) is an irregular but benign (harmless) heart rhythm. Your heartbeat impulse starts in different places in your upper heart chambers (atria) from beat to beat, instead of in the same place with every beat. Even though the heart rhythm is abnormal with this condition, your heart rate is normal (60 to 100 beats per minute). This sets it apart from similar abnormal heart rhythms.

A record (EKG) of your heart rhythm will show variety in the P waves, which your atria make. The P waves have different sizes and shapes because the signals come from different places in your upper heart chambers. With WAP, you can see at least three P waves that don’t look the same from one heartbeat to the next. With a normal heart rhythm, heartbeat signals start only in the sinus node. If you have a wandering atrial pacemaker, your sinus node may still send signals. But then, cells in another part of your atria send the next two.

Symptoms of wandering atrial pacemaker

Unless your heart rate is slow, this condition usually doesn’t cause symptoms.

But some people may feel:

• Skipped beats (heart palpitations)
• Fatigue
• Dizziness

Wandering atrial pacemaker causes

Causes of wandering atrial pacemaker​ include:

• Lung disease
• Heart valve disease
• Heart disease or ischemia (not enough blood flow)
• Digoxin overdose
• Sick sinus syndrome in older people
• Enhanced vagal tone in athletes (your nervous system adapts easily to changes around you)
• Certain medicines (like those for nasal congestion, asthma, COPD and ADHD)

You can still get this abnormal heart rhythm even without having any of these medical conditions. It can happen in adults and children.

How doctors diagnose a wandering atrial pacemaker rhythm

Healthcare providers often find WAP when they’re not looking for it. They may find it when they’re checking for a different condition or doing a routine test. Tests may include:

• Electrocardiogram (EKG): Electrodes on the outside of your chest send data about your heart’s electrical activity.
• Vectorcardiogram: This software creates a 3D version of your EKG.
• Esophageal EKG: A provider puts a wire through your nose and into your esophagus instead of outside your chest to gather data about your heart’s electrical activity.

How is it treated?

You usually don’t need treatment for WAP. Wandering atrial pacemaker treatment consists of treating the condition that caused it.

When should I see my healthcare provider?

If you have symptoms, contact your provider. You may need to see them once a year if you have a problem with your sinus node.

Questions to ask your provider may include:

• Do you know why I have a wandering atrial pacemaker rhythm?
• Do I need to make changes to the medicines I take?
• Do I need a follow-up visit with you?

What can I expect if I have this condition?

A wandering atrial pacemaker rhythm isn’t dangerous. But it may lead to sick sinus syndrome in some people. You may need medicine or a pacemaker for that. If you’re taking digoxin, your healthcare provider may change your dose of digoxin or stop it completely.