Wandering pacemaker

Bradycardia and other dysrhythmias are common (80% in some series) and occur after the first and subsequent injections of suxamethonium in infants and children. In adults, these effects are seen more commonly after second or later injections, particularly when the interval between the doses is 2-5 minutes. However, it has been suggested that bradycardia and asystole may now be more frequently seen than previously in adults after a single injection of suxamethonium, as a result of the increased use of fentanyl or the omission of atropine beforehand (6). Nodal rhythm and wandering pacemaker are frequent. The bradycardia is sometimes extreme (asystoUc periods of 15-30 seconds duration have been reported). Usually these minor dysrhythmias revert to normal after a few minutes. Halothane can prolong their presence. The incidence of bradycardic asystole is not known, as atropine (the effective therapy) is usually quickly given. 

SaUm MA, DiSessa TG, Watson DC. The wandering pacemaker intraperitoneal migration of an epicardially placed pacemaker and femoral nerve stimnlation. Pediatr Cardiol 1999 20 164-6. 

May be difficult to differentiate wandering pacemaker from PACs... 

Wandering pacemaker (continued) What caueee It What to do... 

Distinguishing 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. 

Carefully examine the P waves. You ll be able to identify at least three different shapes of P waves (see shaded areas below) in wandering 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. 

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