Heart is one of the most important organ of the body supplying blood to all the parts of the body including itself. To achieve this, heart has to contract and relax rhythmically according to the needs of the body. This it achieves by beating constantly throughout life. The beating of heart starts from around 6th week of pregnancy till end of life of the individual. The stimulus to the heart to achieve beating is intrinsic that is arises in the heart itself. This property is known as auto-rhythmicity or automaticity. The cells that specialize in this property comprise only 1% of the total cells present in the heart. The rest are contractile cells. 

The autorhythmic cells exhibit pacemaker activity. These cells do not have a resting potential as other skeletal muscle cells or nerve cells. Instead, they have their membrane potential that slowly depolarizes, or drifts, between action potentials until threshold is reached, at which time the membrane fires or has an action potential. This slow drift to threshold is called pacemaker activity. Through repeated cycles of drift and fire, these autorhythmic cells cyclically initiate action potentials, which then spread throughout the heart to trigger rhythmic beating without any nervous stimulation.
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Frequently asked questions about Arrhythmias

What are the usual causes of developing arrhythmias?

The causes depend on the type of arrhythmia. The bradyarrhythmia may be due to problem in the sinoatrial (SA) node. SA nodal dysfunction may be classified as intrinsic or extrinsic. If it is extrinsic, then the same should be corrected before considering pacemaker therapy. Drugs and autonomic nervous system problems can lead to extrinsic SA nodal dysfunction. Other reasons are 

  • Hypothyroidism, 
  • Sleep apnea, and 
  • Conditions mostly encountered in critically ill patients like 
  • Hypothermia, 
  • Hypoxia, 
  • Increased intracranial pressure, etc. 

If the bradyarrhythmia is caused by problems in the atrioventricular (AV) node, then the following reasons might be responsible:

  • Metabolic or endocrine problems like hyperkalemia, hypermagnesemia, hypothyroidism and adrenal insufficiency
  • Drug related problems like the use of beta-blockers, calcium channel blockers, digitalis, adenosine, antiarrhythmics and lithium
  • Infectious causes like endocarditis, Lyme disease, Chagas’ disease, syphilis, tuberculosis, diphtheria and toxoplasmosis
  • Heritable or congenital problems
  • Inflammatory diseases 
  • Coronary artery disease
What are the different types of arrhythmias?

The main types of arrhythmias encountered in clinical practice are:

  • Sinoatrial (SA) node bradyarrhythmia
  • Atrioventricular (AV) node bradyarrhythmia
  • Supraventricular tachyarrhythmia
  • Paroxysmal supraventricular tachycardia
  • Sinus tachycardia
What are the different types of treatments for arrhythmias?

Pharmacologic therapy includes the use of drugs like beta-blockers or calcium channel blockers. Also antiarrhythmic drugs of class I and III also promote SA node exit block. If the drugs don’t work, then the doctor may take a decision to implant a pacemaker.

Can arrhythmias be treated with drugs?

Drugs such as beta-blockers or calcium channel blockers can be used. Also antiarrhythmic drugs of class I and III also promote SA node exit block. Isoproterenol or atropine administration administered intravenously may increase sinus rate acutely.

What is the role of a pacemaker?

An artificial pacemaker can correct an abnormal low heart rate caused by SA node failure or heart block. Such an implanted device rhythmically generates impulses that spread throughout the heart to drive both the atria and the ventricles at the typical rate of 70 beats per minute. 

What are the different kinds of pacemakers available?

The different types of pacemakers that are available are:

  • Single chamber pacemaker which usually carries impulses to the right ventricle of the heart

  • Dual chamber pacemaker that carries impulses to the right ventricle and the right atrium of the heart. It controls the timing of contractions between two chambers.

  • Biventricular pacemaker involves biventricular pacing which is also known as cardiac resynchronization therapy. It is for people who have heart failure due to abnormal electrical systems. This type of pacemaker stimulates both the ventricles for efficient beating of the heart.
What is the life of a pacemaker?

Usually the battery in the pacemaker lasts an average of 15 years. When it wears out, the pacemaker’s pulse generator is replaced.

What are the complications of a pacemaker surgery?

The surgery of the pacemaker carries some complications like infection at the site of the surgery or swelling, bruising or bleeding at the generator site especially if the patient takes blood-thinning medications. The other complications may include damage to the adjoining nerves and blood vessels and collapsed lung. 

What precautions need to be exercised if I have a pacemaker?
Since pacemaker is an electrical current generator placed inside the body, it can create some complications but be assured it doesn’t get electrical interference. Still some precautions need to be taken by the patient. These include:

  • Cell phones need to be kept at least 6 inches away from the pacemaker
  • Passing through the airport security systems can sound the alarm but doesn’t cause any harm.
  • It is necessary to inform medical professionals about the pacemaker. Certain procedures and surgeries can interfere with the pacemaker. These include imaging techniques like MRI and CT scans; cancer radiation treatment; electrocautery to control bleeding during surgery; and shock-wave lithotripsy to break up large kidney stones or gallstones.

Recent Articles

The autorhythmic cells are present in special sites in the heart. These sites are the sinoatrial (SA) node, the atrioventricular (AV) node, the bundle of His and Purkinje fibres. The rate of SA node is the highest being 70-80 beats per minute. This is why the normal pacemaker activity is driven by the SA node. Once an action potential is generated, it is propagated throughout the rest of the myocardium via gap junctions and the specialized conduction system. Thus SA node is known as the pacemaker of the heart. If for some reason, the SA node is damaged, the AV node takes up the role of pacemaker and the heartbeat slows down. Sometimes, Purkinje fiber may become excitable and fire at a rate that is much higher than the normal firing rate of the SA node. This abnormally excitable area is referred to as an ectopic focus. It initiates a premature action potential that spreads throughout the rest of the heart before the SA node can initiate a normal action potential. the contraction caused as a result of this is termed as premature ventricular contraction (PVC). If the firing from the ectopic continues, the pacemaker activity shifts from the normal SA node to this focus. As a result, the heart rate abruptly increases and continues till the ectopic focus returns to normal. These overly irritable areas may be the causes of heart disease, but more frequently they occur in response to anxiety, lack of sleep or excess caffeine, nicotine or alcohol consumption. An artificial pacemaker can correct an abnormal low heart rate caused by SA node failure or heart block. Such an implanted device rhythmically generates impulses that spread throughout the heart to drive both the atria and the ventricles at the typical rate of 70 beats per minute. 
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