Question: What is the EKG diagnosis?
Answer: Wandering pacemaker
Discussion: Wandering pacemaker is characterized by 2-3 P wave morphologies and can be associated with variable PR interval (usually one PR interval length per P wave morphology). Rhythm will follow the background sinus rhythm.
In this patient, baseline rhythm is sinus arrhythmia. Each beat is a sinus beat (P, followed by QRS).
3 different P wave morphologies are noted (inverted, flat, and upright in rhythm strip - lead II). PR interval is 80 ms with inverted P wave and is ~120 ms with upright P wave.
This is not premature atrial contraction - because the complexes are not premature when a different P wave morphology appears!
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