What Is a Wandering Atrial Pacemaker and What Should You Know About It

What Is a Wandering Atrial Pacemaker and What Should You Know About It

What does wandering atrial pacemaker mean? Any abnormality or irregularity with the heart’s rhythm counts as an arrhythmia. Wandering atrial pacemaker is a peculiar type of arrhythmia that entails the switching of pacemaker roles between the two upper chambers of your heart. It may or may not be an arrhythmia to worry about depending on the symptoms, or lack thereof, that you are displaying. Today, we discuss everything you should know about wandering atrial pacemakers, including how cardiac implant monitoring services may be of assistance in this fight. Let’s get started.

Is a wandering atrial pacemaker dangerous?

Not all heart arrhythmias are dangerous. If anything, the majority of heart arrhythmias are typically no cause for concern, especially if they are not accompanied by any symptoms. 

However, we must also note that, sometimes, an arrhythmia can be a precursor or manifestation of more serious heart illnesses and should therefore not be discarded without in-depth examination. Thus the need for pacemaker monitoring services just to be sure.

So is wandering atrial pacemakers serious? The consensus seems to be that you shouldn’t lose sleep over this type of arrhythmia. It is typically harmless and does not count as a serious medical condition. While it is conventionally harmless in most cases, it still doesn’t hurt to peruse further medical investigation to expunge any doubts.

What causes a wandering atrial pacemaker?

To better understand the trigger behind the wandering atrial pacemaker, we need to, first of all, talk about the vagus nerve(s). This system performs several duties within our bodies and has a say in influencing: 

  • Reflex actions (vomiting, sneezing, you name it)
  • Digestion
  • Rate of respiration 
  • Heart rate
  • Digestion and more 

Wandering atrial pacemaker is hypothesized to occur due to problems with the vagal nerves or rather an offset in vagal tone. (Note the use of the word “hypothesis” because there’s limited evidence for this theory). 

Whatever the trigger, it is a fact that these fluctuations intermittently shift pacemaker duties from the SA node, which is considered to be our heart’s natural pacemaker, to the AV nodal area and then back again. During these exchanges, your heart may still beat normally. 

In other words, we may also say that wandering atrial pacemaker occurs when the control of your heart wanders from your natural pacemaker to its opposite upper chamber, hence how this arrhythmia gets its name. 

Symptoms of wandering atrial pacemaker

Wandering atrial pacemaker can be asymptotic, and that’s to mean that you could have this arrhythmia and display no symptoms whatsoever. Nonetheless, you may feel a fluttering sensation in your heart or notice an elevated heart rate. 

That said, here’s a little more on how to identify wandering atrial pacemakers, for the rare cases where symptoms surface.

Key wandering atrial pace symptoms may include: 

  • Chest tightness (or increased pressure in the chest area)
  • Shortness of breath 
  • Unexplained fatigue 
  • Dizziness 

In case you feel any discomforts with your heartbeat or exhibit one or more of the above signs, it’s time to consult a physician for a proper diagnosis. 

Wandering atrial pacemaker risk factors

One of the key triggers for this type of heart irregularity is underlying health conditions, the most notable of which is asthma. This increased risk is not really down to the actual disease of asthma per se but rather to the medication used to manage it, namely β2-agonists. 

These medications can result in electrolyte imbalances, particularly in severe asthma patients who require treatment in high doses. Overall, electrical disturbances afflict 9 in 10 asthma patients who use the aforementioned medication to manage their condition. 

Additionally, other illnesses with ties to wandering atrial pacemaker also include: 

  • Chronic bronchitis
  • COPD
  • Emphysema
  • Sleep Apnea

How physicians diagnosis wandering atrial pacemaker  

Physicians can choose to rely on pacemaker monitoring services such as Techindia’s to unearth a wandering atrial pacemaker diagnosis. This arrhythmia usually crops up in an ECG strip as inconsistencies or rather abnormalities in your P wave. In particular, here’s what an ECG technician will be concerned with in the strip when diagnosing this arrhythmia:  

  • The position of the P wave
  • Its size 
  • The shape of the P wave
  • Variable PR interval
  • Normal QRS i.e. 0.06 through 0.10 seconds
  • Irregular rhythm (may still be regular though)
  • Normal heart rate (60 to 100 bpm)

When it comes to how to identify wandering atrial pacemakers on ECG, the physician will largely be concerned with certain P wave trends or discrepancies. In particular, an ECG for wandering atrial pacemaker rhythm may exhibit 3 or more varying P-wave morphologies with one ECG lead. 

It’s worth pointing out that these different morphologies occur as pacemaker duties shift from the heart’s natural pacemaker to the atria and return to the SA node once more, and so on. It is this pattern of the ECG that is of particular interest when picking out a wandering atrial pacemaker. 

How to treat wandering atrial pacemaker 

So how do you go about wandering atrial pacemaker treatment? It’s important to point out that many cases of wandering atrial pacemakers don’t require medical intervention. But don’t assume so straight away. First, have a chat with your doctor to ensure that’s the case if you have suspicions of an arrhythmia. 

In cases where symptoms are severe or frequent or both, medication such as beta-blockers is one treatment option your physician may want to explore. In hindsight, wandering atrial pacemaker could also be a symptom of an underlying condition. Physicians can investigate typical triggers such as lung disease or sick sinus syndrome, and explore the corresponding treatment option accordingly. 

It is not to be completely disregarded

Do you suspect that you have a wandering atrial pacemaker or an arrhythmia at large?  While this arrhythmia is not usually serious, you may be mistaking it for multifocal atrial tachycardia, which is a different kettle of fish in terms of severity. Most of their symptoms overlap, but the crucial difference is multifocal atrial tachycardia may come with a rapid heart rate in comparison to wandering atrial pacemaker. More importantly, it’s quite a dangerous type of arrhythmia that needs to be dealt with as soon as possible. Reach out to your physician in case of any suspicions, or turn to Techindia’s cardiac implant monitoring services for more information. 


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