Wandering atrial pacemaker
Also calledWAP · wandering pacemaker · wandering atrial pacemaker
Definition
A supraventricular rhythm at a rate below 100 bpm in which the pacemaker site shifts from the sinoatrial node to other atrial sites and/or the AV junction and back, so the P waves change shape from beat to beat (at least 3 different P-wave morphologies), with varying PR and P-P (and thus R-R) intervals and a slightly irregular rhythm. QRS complexes usually look normal. It is generally benign, has been linked to vagal stimulation, and has been found at rest in a small proportion of trained athletes. It differs from multifocal atrial tachycardia only in rate (below versus above 100 bpm).
Clinical noteBeats arising from the AV junction may show no visible P wave, or an inverted (retrograde) P wave in II, III and aVF with a short PR interval.
Sources
- Bhattacharjee S, Khanna P, Bansal S, Maitra S. Intraoperative wandering atrial pacemaker with isoflurane anaesthesia. Indian J Anaesth. 2016;60(6):441-442. doi.org/10.4103/0019-5049.183384
- Singh RK. Electrical injury and wandering atrial pacemaker. Cureus. 2021;13(9):e18335. doi.org/10.7759/cureus.18335
- Samesima N, God EG, Kruse JCL, et al. Brazilian Society of Cardiology guidelines on the analysis and issuance of electrocardiographic reports - 2022. Arq Bras Cardiol. 2022;119(4):638-680. doi.org/10.36660/abc.20220623
- Mason JW, Hancock EW, Gettes LS. Recommendations for the standardization and interpretation of the electrocardiogram: Part II: electrocardiography diagnostic statement list. Circulation. 2007;115(10):1325-1332. doi.org/10.1161/CIRCULATIONAHA.106.180201
- Bjørnstad H, Storstein L, Meen HD, Hals O. Electrocardiographic findings in athletic students and sedentary controls. Cardiology. 1991;79(4):290-305. doi.org/10.1159/000174893
Last reviewed 2 October 2026. Every definition in the EKG Dictionary cites the guideline, consensus statement or original paper it comes from.