Now, if we measure out the interval between each SA node fire, we see that it should have fired here, but it doesn’t because it was depolarized by the ectopic focus.
One important effect of the premature depolarization is that the ectopic focus will depolarize the cells of the SA node, causing the SA node to skip a cycle.
With low levels of extracellular calcium, voltage-gated sodium channels are less stable and more likely to open up, which allows the cell to depolarize more easily, and makes the neuron more excitable.
In this case the wave of depolarization makes it into the atrium and depolarizes the atrium, including the sinus node, so essentially the sinus node resets about 4.4 boxes from the last, or 0.88 seconds.
Remember that at rest, cells are negatively charged relative to the slightly positive outside environment and when they depolarize, the cells become positively charged, leaving a slightly negative charge in the outside environment.
If the ectopic focus originates in the left ventricle, the wave will depolarizing the left ventricle first and then the right ventricle, which produces a QRS complex that looks like a right bundle branch block.
If the ectopic focus originates in the right ventricle, the wave will depolarize the right ventricle first and then the left ventricle, and this produces a QRS complex that looks like a left bundle branch block.