<s>
Wandering	B-Algorithm
atrial	I-Algorithm
pacemaker	I-Algorithm
(	O
WAP	O
)	O
is	O
an	O
atrial	O
rhythm	O
where	O
the	O
pacemaking	B-Algorithm
activity	O
of	O
the	O
heart	O
originates	O
from	O
different	O
locations	O
within	O
the	O
atria	O
.	O
</s>
<s>
This	O
is	O
different	O
from	O
normal	O
pacemaking	B-Algorithm
activity	O
,	O
where	O
the	O
sinoatrial	O
node	O
(	O
SA	O
node	O
)	O
is	O
responsible	O
for	O
each	O
heartbeat	O
and	O
keeps	O
a	O
steady	O
rate	O
and	O
rhythm	O
.	O
</s>
<s>
Causes	O
of	O
wandering	B-Algorithm
atrial	I-Algorithm
pacemaker	I-Algorithm
are	O
unclear	O
,	O
but	O
there	O
may	O
be	O
factors	O
leading	O
to	O
its	O
development	O
.	O
</s>
<s>
Diagnosis	O
of	O
wandering	B-Algorithm
atrial	I-Algorithm
pacemaker	I-Algorithm
is	O
made	O
by	O
an	O
ECG	B-Application
.	O
</s>
<s>
In	O
wandering	B-Algorithm
atrial	I-Algorithm
pacemaker	I-Algorithm
,	O
there	O
are	O
other	O
locations	O
within	O
the	O
atria	O
besides	O
the	O
SA	O
node	O
that	O
are	O
responsible	O
for	O
each	O
heartbeat	O
.	O
</s>
<s>
This	O
is	O
unusual	O
because	O
the	O
SA	O
node	O
,	O
AV	O
node	O
,	O
bundle	B-Algorithm
of	I-Algorithm
His	I-Algorithm
,	O
bundle	O
branches	O
,	O
and	O
Purkinje	B-Algorithm
fibers	I-Algorithm
are	O
the	O
structures	O
that	O
have	O
pacemaking	B-Algorithm
capability	O
.	O
</s>
<s>
Originally	O
,	O
it	O
was	O
believed	O
that	O
the	O
atria	O
had	O
different	O
ectopic	B-Algorithm
foci	I-Algorithm
that	O
were	O
spontaneously	O
depolarizing	O
,	O
each	O
foci	O
acting	O
as	O
a	O
pacemaker	O
for	O
the	O
heart	O
.	O
</s>
<s>
Wandering	B-Algorithm
atrial	I-Algorithm
pacemaker	I-Algorithm
may	O
be	O
seen	O
in	O
young	O
,	O
healthy	O
individuals	O
as	O
well	O
as	O
in	O
the	O
elderly	O
and	O
those	O
with	O
lung	O
disease	O
.	O
</s>
<s>
The	O
cause	O
of	O
wandering	B-Algorithm
atrial	I-Algorithm
pacemaker	I-Algorithm
is	O
unclear	O
.	O
</s>
<s>
For	O
elderly	O
individuals	O
,	O
the	O
rhythm	O
may	O
be	O
caused	O
by	O
sinus	B-Algorithm
node	I-Algorithm
dysfunction	I-Algorithm
.	O
</s>
<s>
In	O
rare	O
cases	O
,	O
digoxin	O
toxicity	O
can	O
cause	O
wandering	B-Algorithm
atrial	I-Algorithm
pacemaker	I-Algorithm
.	O
</s>
<s>
Wandering	B-Algorithm
atrial	I-Algorithm
pacemaker	I-Algorithm
does	O
n't	O
usually	O
have	O
symptoms	O
because	O
it	O
is	O
commonly	O
a	O
benign	O
rhythm	O
.	O
</s>
<s>
It	O
is	O
usually	O
found	O
incidentally	O
on	O
an	O
ECG	B-Application
for	O
other	O
medical	O
indications	O
that	O
require	O
a	O
heart	B-Algorithm
rhythm	I-Algorithm
screening	O
.	O
</s>
<s>
Upon	O
physical	O
examination	O
,	O
it	O
can	O
be	O
found	O
by	O
having	O
an	O
irregularly	O
irregular	O
rhythm	O
,	O
similar	O
to	O
how	O
atrial	B-Application
fibrillation	I-Application
is	O
described	O
.	O
</s>
<s>
An	O
ECG	B-Application
would	O
then	O
be	O
performed	O
to	O
find	O
the	O
underlying	O
cause	O
of	O
the	O
rhythm	O
disturbance	O
.	O
</s>
<s>
The	O
heart	B-Algorithm
rhythm	I-Algorithm
is	O
seen	O
through	O
an	O
electrocardiogram	B-Application
.	O
</s>
<s>
To	O
make	O
the	O
diagnosis	O
,	O
there	O
must	O
be	O
at	O
least	O
3	O
different	O
P-wave	B-Algorithm
morphologies	O
in	O
a	O
single	O
ECG	B-Application
lead	O
due	O
to	O
the	O
shifting	O
of	O
the	O
pacemaker	O
in	O
the	O
atria	O
.	O
</s>
<s>
This	O
is	O
different	O
from	O
normal	O
sinus	O
rhythm	O
where	O
one	O
will	O
see	O
the	O
same	O
P-wave	B-Algorithm
morphology	O
through	O
the	O
same	O
lead	O
because	O
each	O
beat	O
is	O
started	O
from	O
the	O
SA	O
node	O
.	O
</s>
<s>
The	O
P-wave	B-Algorithm
is	O
normally	O
upright	O
or	O
positive	O
in	O
leads	O
I	O
and	O
II	O
,	O
and	O
therefore	O
may	O
be	O
the	O
helpful	O
when	O
determining	O
changing	O
P-wave	B-Algorithm
morphologies	O
.	O
</s>
<s>
Other	O
common	O
changes	O
that	O
are	O
seen	O
on	O
ECG	B-Application
with	O
wandering	B-Algorithm
atrial	I-Algorithm
pacemaker	I-Algorithm
include	O
differing	O
PR	B-Algorithm
intervals	I-Algorithm
and	O
PP	O
intervals	O
.	O
</s>
<s>
Another	O
heart	B-Algorithm
rhythm	I-Algorithm
similar	O
to	O
wandering	B-Algorithm
atrial	I-Algorithm
pacemaker	I-Algorithm
is	O
multifocal	B-Algorithm
atrial	I-Algorithm
tachycardia	I-Algorithm
.	O
</s>
<s>
Both	O
arrhythmias	O
have	O
at	O
least	O
3	O
different	O
P-wave	B-Algorithm
morphologies	O
in	O
a	O
single	O
ECG	B-Application
lead	O
,	O
but	O
the	O
heart	O
rate	O
is	O
different	O
.	O
</s>
<s>
When	O
the	O
heart	O
rate	O
is	O
lower	O
than	O
100	O
beats	O
per	O
minute	O
,	O
the	O
heart	B-Algorithm
rhythm	I-Algorithm
is	O
considered	O
wandering	B-Algorithm
atrial	I-Algorithm
pacemaker	I-Algorithm
.	O
</s>
<s>
When	O
the	O
heart	O
rate	O
is	O
greater	O
than	O
100	O
beats	O
per	O
minute	O
,	O
the	O
heart	B-Algorithm
rhythm	I-Algorithm
is	O
considered	O
multifocal	B-Algorithm
atrial	I-Algorithm
tachycardia	I-Algorithm
.	O
</s>
<s>
In	O
the	O
setting	O
of	O
suspected	O
sinus	B-Algorithm
node	I-Algorithm
dysfunction	I-Algorithm
manifesting	O
as	O
wandering	B-Algorithm
atrial	I-Algorithm
pacemaker	I-Algorithm
,	O
evaluation	O
for	O
pacemaker	O
placement	O
may	O
be	O
done	O
due	O
to	O
sinus	O
node	O
damage	O
.	O
</s>
