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Pacemaker

Heart's Electrical System

The heart is, in the simplest terms, a pump made up of muscle tissue. The heart's pumping action is regulated by an electrical conduction system that coordinates the contraction of the various chambers of the heart.

How does the heart beat?

An electrical stimulus is generated by the sinus node (also called the sinoatrial node, or SA node), which is a small mass of specialized tissue located in the right atrium (right upper chamber of the heart). In an adult, the sinus node generates an electrical stimulus regularly (for adults, 60 to 100 times per minute under normal conditions). This electrical stimulus travels down through the conduction pathways (similar to the way electricity flows through power lines from the power plant to your house) and causes the heart's lower chambers to contract and pump out blood. The right and left atria (the two upper chambers of the heart) are stimulated first and contract a short period of time before the right and left ventricles (the two lower chambers of the heart). 
The electrical impulse travels from the sinus node to the atrioventricular node (also called AV node), where impulses are slowed down for a very short period, then continue down the conduction pathway via the bundle of His into the ventricles. The bundle of His divides into right and left pathways to provide electrical stimulation to the right and left ventricles.
Normally at rest, as the electrical impulse moves through the heart, the heart contracts about 60 to 140 times a minute, depending on a person's age (infants normally have very high heart rates). Each contraction of the ventricles represents one heartbeat. The atria contract a fraction of a second before the ventricles so their blood empties into the ventricles before the ventricles contract.
Under some abnormal conditions, certain heart tissue is capable of starting a heartbeat, or becoming the pacemaker. An arrhythmia (abnormal heartbeat) occurs when:

  • The heart's natural pacemaker develops an abnormal rate or rhythm

  • The normal conduction pathway is interrupted

  • Another part of the heart takes over as pacemaker

In any of these situations, the body may not receive enough blood because the heart cannot pump out an adequate amount with each beat as a result of the arrhythmia's effects on the heart rate. The effects on the body are often the same, however, whether the heartbeat is too fast, too slow, or too irregular. Some symptoms of arrhythmias include, but are not limited to:

  • Weakness

  • Fatigue

  • Palpitations

  • Low blood pressure

  • Dizziness

  • Fainting

The symptoms of arrhythmias may resemble other medical conditions. Consult your physician for a diagnosis.