Sinoatrial node of the next action potential. Pacemaker cells, however, don’t have this resting phase. Instead, immediately after one action potential, the membrane potential of these cells begins to depolarise again automatically, this is known as the pacemaker potential. Once the pacemaker potential reaches a set value, known as the threshold value, it then produces an action potential. Other cells within the heart (including the purkinje fibers and atrioventricular node; AVN) can also initiate action potentials; however, they do so at a slower rate and therefore, if the SA node is working, it usually beats the AVN to it. Outlined below are
Artificial cardiac pacemaker which is the mode of choice when atrioventricular conduction is intact but the natural pacemaker the sinoatrial node is unreliable – sinus node disease (SND) or sick sinus syndrome. Where the problem is atrioventricular block (AVB) the pacemaker is required to detect (sense) the atrial beat and after a normal delay (0.1–0.2 seconds) trigger a ventricular beat, unless it has already happened – this is VDD mode and can be achieved with a single pacing lead with electrodes in the right atrium (to sense) and ventricle (to sense and pace). These modes AAIR and VDD are unusual in the US