Pacemakerterület

Pacemakerterület, or pacemaker territory, refers to the region of cardiac tissue that is paced or activated by a pacemaker, whether the heart’s natural pacemaker or an implanted device. The concept encompasses where impulses originate and how they propagate through the heart muscle.

In natural pacing, the sinoatrial (SA) node in the right atrium is the primary pacemaker. Its impulses usually set the heart rate and rhythm, with the atrioventricular (AV) node or the His–Purkinje system able to take over if the SA node fails. These secondary pacemaker areas produce slower rhythms and can change the overall pacing territory of the heart, especially in disease states such as sick sinus syndrome or heart block.

In artificial pacing, the pacemaker territory is defined by the location of the pacing leads and the pacing configuration. The implanted generator delivers impulses that capture the myocardium at the lead tip, creating a new pacing territory that may involve the right atrium, the right ventricle, or both. Multichamber devices (dual- or biventricular systems) can pace and sense in multiple chambers. Left ventricular pacing via the coronary sinus is used in resynchronization therapy (CRT). The effectiveness of pacing depends on capture threshold, lead position, tissue quality, and the absence of scar tissue or conduction blocks.

Understanding pacemaker territory helps optimize lead placement, pacing mode, and device programming to ensure reliable capture, appropriate heart rate, and synchronized contraction. It also informs troubleshooting when sensing issues or loss of capture occur. See also pacemaker, capture, threshold, and cardiac resynchronization therapy.