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How can a pacemaker help my atrial fibrillation?

Dr. Mohammad E. Mortada, MD
Cardiologist (Heart Specialist)

Pacemakers may help atrial fibrillation (AF) in several ways, depending on where the pacemaker is placed. Here is what is expected in various types of procedures:

  • Atrial pacing: Studies are being done to find out if pacing with a permanent pacemaker in the right atrium or both upper chambers is a way to decrease the episodes of AF. Early results show a small number of people can benefit. Some people have extra beats, slow pulses and pauses, or both, that start their AF episodes. A pacemaker may help make the heartbeat more regular and help cut down the number of AF episodes these patients have.
  • Ventricular pacing: Pacing with a permanent pacemaker in the lower chambers may be necessary for some patients who take medications for AF. Sometimes the medications exert strong rate control with the side effect of a slow pulse. The lower chambers then need help keeping the pulse at a rate that is within normal ranges. Ventricular pacemakers control the lower chambers by adding in missed beats. Atrial fibrillation can continue to create irregular or rapid beats that travel through the natural conduction system to enter the lower chambers. An AV node ablation procedure can prevent this by interrupting this electrical connection.
  • Dual chamber pacemakers: Atrial and ventricular pacing is combined into one device to perform a variety of pacing functions to coordinate the upper and lower chambers.
Dr. Andrew J. Brenyo, MD
Cardiologist (Heart Specialist)

Pacemakers are often utilized for patients with atrial fibrillation to allow the use of medications to slow the heart rate without making your heart rate too slow. The only function that a pacemaker serves is to make sure that the heart rate does not drop below a set point determined at device implant and follow up. Medications are then given to prevent prolonged elevations in the heart rate beyond where the pacemaker is set to provide heart rate support. Increasingly, the use of ablation on the connection between the top chambers and the bottom chambers of the heart (the AV node) along with placement of a biventricular pacemaker is used to provide definitive rate control of atrial fibrillation and remove the need for medications to slow the heart. The benefit of this approach is that, although it does not treat the atrial fibrillation, it does remove the irregularity in the pulse (which is now dependent upon the pacemaker) and may eliminate the need for medications that slow the heart rate, which can have intolerable side effects. We know that patients treated with an AV node ablation and an activity responsive biventricular pacemaker experience an improvement in their quality of life similar to those that have a diagnosis of atrial fibrillation but maintain a normal rhythm.

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A pacemaker can help atrial fibrillation by raising the heart rate if it begins to slow.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.