Alila Academy

Wandering atrial pacemaker, or WAP, is an atrial arrhythmia that occurs when the pacemaker of the heart shifts between the SA node and other ectopic sites in the atria. In other words, it “wanders” among different foci.

Instead of the normal smooth upright P wave produced by the SA node, ectopic foci produce P-waves with unusual shapes. 

Because different ectopic sites can have different automaticity and may fire at different rates, the PR intervals are also variable and heart rhythm is irregular.  

By definition, WAP must have at least three different P wave morphologies and a ventricular rate of less than 100 beats per minute. 

Multifocal atrial tachycardia, or MAT, is a more serious version of wandering atrial pacemaker in which heart rate is greater than 100 beats per minute. 

On an ECG, MAT is often misdiagnosed ...

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