In this column, the cardiac rhythms known as wandering atrial pacemaker (WAP) and multifocal ectopic atrial tachycardia are considered. Unlike other atrial arrhythmias, such as atrial fibrillation and atrial flutter, these heart rhythms are not caused by intrinsic pathological conduction problems and are usually eliminated by correcting noncardiac underlying conditions, such as respiratory insufficiency and electrolyte disorders. The common characteristic of these rhythms is variation in the shape or morphology of the P wave in a single electrocardiograph (ECG) lead. The terms WAP and multifocal ectopic atrial tachycardia are not interchangeable: WAP occurs in less-ill individuals, so it is worthwhile to clarify these designations. Critical care and acute care nurses occasionally see both rhythms in practice.

In 2007, the American Heart Association published a limited set of clinically useful diagnostic statements (190 primary statements plus secondary statements) to promote uniformity in ECG...

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