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A pacemaker, also known as an artificial cardiac pacemaker, is an implanted medical device that generates electrical pulses delivered by electrodes to one or more of the chambers of the heart. Each pulse causes the targeted chamber(s) to contract and pump blood, [ 3 ] thus regulating the function of the electrical conduction system of the heart .
The voltage region encompassed by this transition is commonly known as pacemaker phase, or slow diastolic depolarization or phase 4. The duration of this slow diastolic depolarization (pacemaker phase) thus governs the cardiac chronotropism.
Image showing the cardiac pacemaker or SA node, the primary pacemaker within the electrical conduction system of the heart The cardiac pacemaker is the heart 's natural rhythm generator. It employs pacemaker cells that produce electrical impulses, known as cardiac action potentials , which control the rate of contraction of the cardiac muscle ...
During each heartbeat, a healthy heart has an orderly progression of depolarization that starts with pacemaker cells in the sinoatrial node, spreads throughout the atrium, and passes through the atrioventricular node down into the bundle of His and into the Purkinje fibers, spreading down and to the left throughout the ventricles. [12]
Depolarization propagates through cardiac muscle very rapidly. Cells of the ventricles contract nearly simultaneously. The action potentials of cardiac muscle are unusually sustained. This prevents premature relaxation, maintaining initial contraction until the entire myocardium has had time to depolarize and contract. Absence of tetany.
Because the pacemaker potential represents the non-contracting time between heart beats , it is also called the diastolic depolarization. The amount of net inward current required to move the cell membrane potential during the pacemaker phase is extremely small, in the order of few pAs, but this net flux arises from time to time changing ...
Instead, it arises from a group of specialized cells known as pacemaker cells, that have automatic action potential generation capability. In healthy hearts, these cells form the cardiac pacemaker and are found in the sinoatrial node in the right atrium. They produce roughly 60–100 action potentials every minute.
HCN4 is the main isoform expressed in the sinoatrial node, but low levels of HCN1 and HCN2 have also been reported.The current through HCN channels, called the pacemaker current (I f), plays a key role in the generation and modulation of cardiac rhythmicity, [13] as they are responsible for the spontaneous depolarization in pacemaker action potentials in the heart.