Wandering Atrial Pacemaker is best described by which statement?

• A. Rate <100 bpm with irregular atrial rhythm and P waves of varying morphologies
• B. Rate >100 bpm with identical P waves
• C. No P waves
• D. Sawtooth flutter waves

Answer: (A)

Wandering atrial pacemaker happens when the dominant pacemaker site shifts among the sinus node and other atrial or AV nodal regions, so the P waves come from different atrial foci. That drift produces multiple P-wave morphologies from beat to beat and an irregular rhythm. The rate is typically less than 100 beats per minute, which helps distinguish it from similar rhythms that are faster.

So the description that best fits this pattern shows an irregular rhythm with P waves of varying morphology and a rate under 100 bpm. If the rate were above 100 bpm with the same variability in P waves, you’d be looking at multifocal atrial tachycardia. If there are no P waves, it’s a junctional rhythm, and if you see sawtooth flutter waves, that’s atrial flutter.