Pacemaker

A system that sends electrical impulses to the heart in order to set the heart rhythm. The pacemaker can be the normal “natural” pacemaker of the heart or it can be an electronic device.

The natural pacemaker of the heart is the sinus node, one of the major elements in the cardiac conduction system, the system that controls the heart rate. This stunningly designed system generates electrical impulses and conducts them throughout the muscle of the heart, stimulating the heart to contract and pump blood.

The sinus node consists of a cluster of cells that are situated in the upper part of the wall of the right atrium (the right upper chamber of the heart). The electrical impulses are generated there. The sinus node is also called the sinoatrial node or, for short, the SA node.

The electrical signal generated by the sinus node moves from cell to cell down through the heart until it reaches the atrioventricular node (AV node), a cluster of cells situated in the center of the heart between the atria and ventricles. The AV node serves as a gate that slows the electrical current before the signal is permitted to pass down through to the ventricles. This delay ensures that the atria have a chance to fully contract before the ventricles are stimulated. After passing the AV node, the electrical current travels to the ventricles along special fibers embedded in the walls of the lower part of the heart.

Although there are different types of artificial pacemakers, all are designed to treat bradycardia, a heart rate that is too slow. Some pacemakers function continuously and stimulate the heart at a fixed rate or at an increased rate during exercise. A pacemaker can also be programmed to detect an overly long pause between heartbeats, and then stimulate the heart. For more information, see Artificial pacemaker.