A wandering pacemaker is a type of arrhythmia characterized by a change in the location of the heart's natural pacemaker. The result is an irregular heartbeat, with a P wave, the wave that indicates a change in electrical activity from the right atrium to the left atrium, that moves when the heartbeat is viewed on an electrocardiograph (ECG). This arrhythmia is usually not a cause for concern and does not require further treatment. However, there may be cases where it is associated with another health problem that requires attention.
The heart's natural pacemaker is located in the sinoatrial (SA) node, an area in the upper portion of the right atrium. This area includes a group of pacemaker cells that determine heart rhythm. In someone with a wandering pacemaker, sometimes cells in the atrioventricular (AV) node, in the lower area of the right atrium, temporarily take over pacing duties. This results in heartbeat irregularities that can usually be felt by the patient, and which will also show up as irregularities on an ECG.
The vagus nerve is a nerve that regulates the heartbeat; its "tone" is the level of activity or impulses sent by the nerve. A decrease in vagal tone can cause the AV node to start regulating the heartbeat. When the tone rises, the SA node will resume its proper function. This type of malfunction can occur in response to stress and other pressures and can occur independently or in connection with certain medications or conditions.
A doctor can diagnose a wandering pacemaker with the help of an ECG to visualize the heartbeat. By examining the patterns on the ECG, the doctor can determine not only that the patient has an arrhythmia, but also what type of arrhythmia they have and what may be causing it. Wandering pacemakers are a form of atrial arrhythmia, because they originate in the right atrium of the heart.
Patients who have a errant pacemaker may want to make sure it is noted on their charts so that when they interact with new care providers, their care providers don't worry or freak out about the arrhythmia. Some patients may also need to attend cardiology appointments in order to monitor cardiac function to confirm that the heart is still healthy and to determine whether more aggressive treatment options should be pursued.