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What is a Wandering Atrial Pacemaker?

By Misty Wiser
Updated Feb 27, 2024
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The wandering atrial pacemaker (WAP) is an arrhythmia that occurs when the natural pacemaker of the heart changes from the sinoatrial (SA) node to the atrioventricular (AV) node. It shows as a change in the P waves on an electrocardiogram (EKG). P waves invert when the heart rate slows down, and will return to a normal pattern when the heart speeds back up again.

It is possible for a wandering atrial pacemaker to occur more often in the young and among athletes. Doctors believe this is because of an augmented vagal tone. An increase in the vagal tone causes a slower heart rate and allows the AV node or the atria to take over the heart’s rhythm. When the vagal tone decreases, the heart reverts to the normal pacemaker of the SA node. This wandering from SA to AV node may or may not result in an irregular heartbeat.

The condition can manifest itself during a person’s normal sleep cycle. It may also occur as a side effect of some medications, including digitalis. A WAP may also be indicative of developing heart disease or a cardiac sinus disorder.

Treatment for a wandering atrial pacemaker is not usually necessary, but there may be a co-existing condition that requires treatment. For example, if the wandering atrial pacemaker occurs at the same time as either a tachycardia, a fast heartbeat, or a bradycardia, a slow heartbeat, an artificial pacemaker may be implanted to regulate the heartbeat.

An artificial pacemaker is implanted during an operation that normally spans three hours. The patient will have an intravenous (IV) line inserted, and an anesthetic will be administered. Wires that lead to the pacemaker box will be threaded through a vein to the heart. The wires will then be attached to the pacemaker, and the pacemaker will be implanted into the chest or abdomen.

A hospital stay is usually required for a day or two after a pacemaker is implanted to ensure the device is working properly. Some people may experience pain and swelling around the implant site during the first month of recovery. Normal activities may be resumed within seven to ten days after the operation. Heavy lifting and vigorous exercise is not usually recommended for at least a month after the procedure.

The pacemaker operation is known to have a few risks. Some may develop an infection or nerve damage after the procedure. Very rarely, a lung has collapsed during the implantation. Most often, the operation is successful and recovery occurs without any complications.

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Discussion Comments
By bythewell — On Mar 10, 2013

It's interesting that this condition can occur more often in young people and athletes. I wonder if it's related to the sort of fluttering heartbeat I get sometimes. It doesn't happen often, but sometimes after I've had too much exercise, or I've had a lot of caffeine I get some palpitations and feel like I need to breathe deeply in order to slow my heart down.

It only ever lasts a few moments, but I wonder if it is a wandering atrial pacemaker issue.

By MrsPramm — On Mar 10, 2013

@browncoat - Well, I always say, on the plus side I'm never likely to need artificial defibrillation again, because my heart will never suffer from fibrillation again, which is what it's called when it stops beating.

So, it can be scary to think that your life is reliant on a machine, but in some ways the machine is even better than the original model.

By browncoat — On Mar 09, 2013

My mother had to have a pacemaker put in over a year ago. She started out with what the doctors thought was this condition, but gradually her heart rhythm got worse and worse until they finally decided they probably needed to operate.

Even then, they were telling her that it was 'just in case' and to improve her quality of life, rather than because she really needed it to live.

Recently she went for a checkup and they turned off her pacemaker to see what would happen. What happened was her heart stopped beating altogether.

So basically, if they hadn't put in the pacemaker, she might have died already. I'm glad they did it, even though it was supposedly 'just in case.'

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