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"Wandering atrial pacemaker (multifocal atrial rhythm) is an irregularly irregular rhythm caused by the random discharge of multiple ectopic atrial foci. By definition, heart rate is ≤ 100 beats/min. This arrhythmia most typically occurs in patients who have a pulmonary disorder and are hypoxic, acidotic, theophylline-intoxicated, or a combination. On ECG, P-wave morphology differs from beat to beat and there are 3 or more distinct P-wave morphologies. The presence of P waves distinguishes wandering atrial pacemaker from atrial fibrillation."