Ectopic pacemaker

An ectopic pacemaker, also known as ectopic focus or ectopic foci, is an excitable group of cells that causes a premature heart beat outside the normally functioning SA node of the heart. It is thus a cardiac pacemaker that is ectopic, producing an ectopic beat. Acute occurrence is usually non-life-threatening, but chronic occurrence can progress into tachycardia, bradycardia or ventricular fibrillation. In a normal heart beat rhythm, the SA node usually suppresses the ectopic pacemaker activity due to the higher impulse rate of the SA node. However, in the instance of either a malfunctioning SA node or an ectopic focus bearing an intrinsic rate superior to SA node rate, ectopic pacemaker activity may take over the natural heart rhythm. This phenomenon (an intrinsically slower pacemaker activity being unmasked by failure of faster pacemaker tissue 'upstream') is called an escape rhythm, the lower rhythm having escaped from the dominance of the upper rhythm. As a rule, premature ectopic beats (i.e. with a shorter than the prevailing preceding R-R' interval) indicate increased myocyte or conducting tissue excitability, whereas late ectopic beats (i.e. with a prolonged preceding R-R' interval) indicate proximal pacemaker or conduction failure with an escape 'ectopic' beat. Isolated ectopic beats frequently cause no symptoms, although the most common symptom is the perception of a 'missed beat'. This occurs because the person notices the prolonged gap between the early (ectopic) beat and the next normal beat. Palpitations Feeling faint Ectopic pacemakers can occur within healthy hearts in response to various stimulating events, they can be caused by automaticity or triggered activity, such as: Increased local parasympathetic nervous system activity Elevated sympathetic nervous system output Overstimulation from drugs such as caffeine, digitalis, and catecholamines Cardiac Ischemia (particularly ventricular ischemia) – the membranes of apoptotic (dying) cells become "leaky" and cause surrounding tissue to become hyperkalemic or hypercalcemic (high concentration of potassium/calcium), causing random excitation.