Wandering atrial pacemaker

Wandering atrial pacemaker (WAP) is an atrial arrhythmia that occurs when the natural cardiac pacemaker site shifts between the sinoatrial node (SA node), the atria, and/or the atrioventricular node (AV node). This shifting of the pacemaker from the SA node to adjacent tissues is identifiable on ECG Lead II by morphological changes in the P-wave; sinus beats have smooth upright P waves, while atrial beats have flattened, notched, or diphasic P-waves. It is often seen in the very young, very old, and in athletes, and rarely causes symptoms or requires treatment.[1]

Wandering pacemaker
Shifting (wandering) pacemaker



  1. Huff, J. (2016). ECG workout: Exercises in arrhythmia interpretation (7th ed.). Philadelphia, PA: Wolters Kluwer.
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