This is a pleomorphic group of dysrhythmias that result from enlargement of the right atrium, which typically is poorly distended due to the low-pressure state of the chamber. Enlargement can occur due to diseases of the lung, in particular, bronchopulmonary dysplasia and cystic fibrosis that result in the adult equivalent of cor pulmonale. Anatomic enlargement can occur in Epstein anomaly, an abnormal atrialization of the right ventricle. Such conditions result in wandering atrial pacemakers and sinus arrest. Occasionally, bursts of atrial flutter result in low-output states that may result in syncope.
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