Cardiac pacemaker discharge at about 40-60 beats per minute, and are called the "secondary pacemaker". Further down the electrical conducting system of the heart is the Bundle of His. The left and right branches of this bundle, and the Purkinje fibres, will also produce a spontaneous action potential at a rate of 30-40 beats per minute, so if the SA and AV node both fail to function, these cells can become pacemakers. It is important to realize that these cells will be initiating action potentials and contraction at a much lower rate than the primary or secondary pacemaker cells. The SA node
Cardiac cycle is composed of myocytes which initiate their internal contractions without applying to external nerves—with the exception of changes in the heart rate due to metabolic demand. In an electrocardiogram, electrical systole initiates the atrial systole at the P wave deflection of a steady signal; and it starts contractions (systole) of the ventricles at the Q deflection of the QRS complex. (Completing the P wave represents the end of the "ventricular diastole" and the start of the "ventricular systole"—see cycle diagram). The cardiac cycle involves four major stages of activity: 1) "Isovolumic relaxation", 2) Inflow, 3) "Isovolumic contraction", 4) "Ejection". (See