Pathophysiology
         
Wandering Atrial Pacemaker   C5, C6, C7, C8, R24  

A form of multifocal atrial rhythm at a rate of <100bpm. WAP exists when at least 3 ectopic foci in the atrium generate action potentials that result in ventricular conduction. In WAP, each QRS will be preceded by a p-wave (with varying morphologies reflecting varying atrial ectopic foci).

Rhythm Strip
Wandering Atrial Pacemaker Rhythm Strip

Multifocal Atrial Rhythm - Wandering Atrial Pacemaker (61 BPM)

12 Lead EKG
Wandering Atrial Pacemaker 12 Lead EKG