Neural oscillation sinoatrial node normally initiates it, simply because it generates impulses slightly faster than the other areas. Hence, these cells generate the normal sinus rhythm and are called pacemaker cells as they directly control the heart rate. In the absence of extrinsic neural and hormonal control, cells in the SA node will rhythmically discharge. The sinoatrial node is richly innervated by the autonomic nervous system, which up or down regulates the spontaneous firing frequency of the pacemaker cells. Synchronized firing of neurons also forms the basis of periodic motor commands for rhythmic movements. These rhythmic outputs are produced by a group
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