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
Heart block the atrioventricular node ("AV node") which also contains a secondary "pacemaker" that acts as a backup for the SA nodes, then to the bundle of His and then via the bundle branches to the point of the apex of the fascicular branches. Blockages are therefore classified based on where the blockage occurs - namely the SA node ("Sinoatrial block"), AV node ("AV block" or AVB), and at or below the bundle of His ("Intra-Hisian" or "Infra-Hisian block" respectively). Infra-Hisian blocks may occur at the left or right bundle branches ("bundle branch block") or the fascicles of the left bundle branch