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An electrical stimulus is generated by the sinus node (also called the sinoatrial node, or SA node), which is a small area of specialized tissue located in the right atrium (right upper chamber of the heart). Under normal conditions, the sinus node generates an electrical stimulus every time the heart beats (60 to 190 times per minute, depending on the age of the child and his/her activity level).
This electrical stimulus travels down through the conduction pathways (similar to the way electricity flows through power lines from the power plant to your house) and causes the heart's chambers to contract and pump out blood. The right and left atria (the two upper chambers of the heart) are stimulated first and contract a short period of time before the right and left ventricles (the two lower chambers of the heart).
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