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.
