62 year old female who is asymptomatic.
Question 1: What causes the differences in P wave morphology in wandering atrial pacemakers?
Question 2: Based on the the Lead II rhythm strip, what is one possible explanation for this patient's P wave changes?
Question 1: The different P wave morphologies occur because they are originating from different areas of the atrium.
Question 2: This patient may have a lower atrial rhythm (negative P wave in II) competing with sinus rhythm. As the sinus rate increases slightly, it usurps the lower atrial rhythm.