Wandering atrial pacemaker

Common supraventricular tachycardias requiring drug treatment are atrial fibrillation (AF) or atrial flutter, paroxysmal supraventricular tachycardia (PSVT), and automatic atrial tachycardias. Other common supraventricular arrhythmias that usually do not require drug therapy are not discussed in this chapter (e.g., premature atrial complexes, wandering atrial pacemaker, sinus arrhythmia, sinus tachycardia). 

A 3-year-old toddler developed multifocal atrial tachycardia following an iatrogenic overdose of adrenaline accidentally administered (i.v). His ECG showed wandering atrial pacemaker (P-waves with different origins and configurations) that persisted for at least 1 year. This event... 

Aburawi EH, Narchi H, Souid AK. Persistent wandering atrial pacemaker after epinephrine overdosing - a case report. BMC Pediatr 2013 13 1. 

May be difficult to differentiate wandering pacemaker from premature atrial contractions. 

Because premature atrial contractions (PACs) are common, you may miss a wandering pacemaker rhythm unless you examine the rhythm strip carefully. You may find it helpful to look at a rhythm strip that s longer than 6 seconds. 

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