What is the role of pacemakers in managing atrial fibrillation? How can pacemakers help with atrial fibrillation symptoms and treatment? Find the answers to these questions and more in this comprehensive guide.

The Role of Pacemakers in Managing Atrial Fibrillation

Atrial fibrillation (AF or Afib) is a common heart rhythm disorder that can cause an irregular and sometimes rapid heartbeat. While lifestyle changes and medications are often the first line of defense, pacemakers can play a crucial role in managing atrial fibrillation in certain cases.

How Can Pacemakers Help with Atrial Fibrillation?

Pacemakers are small, implantable devices that help regulate the heart’s electrical signals and maintain a steady, normal heart rate. In the context of atrial fibrillation, pacemakers can be used in the following ways:

1. Rate Control

Pacemakers can help control the heart rate in individuals with atrial fibrillation. By delivering electrical impulses to the heart, pacemakers can ensure that the heart does not beat too fast, which is a common problem in atrial fibrillation. This can help alleviate symptoms such as palpitations, shortness of breath, and fatigue.

2. Rhythm Restoration

In some cases, pacemakers can be used to help restore a normal heart rhythm in individuals with atrial fibrillation. This is known as “atrial pacing” and involves the pacemaker stimulating the upper chambers of the heart (the atria) to contract in a coordinated manner, effectively restoring a normal heart rhythm.

3. Prevention of Complications

Pacemakers can also play a role in preventing complications associated with atrial fibrillation, such as blood clots and stroke. By maintaining a steady heart rate, pacemakers can reduce the risk of blood pooling in the heart, which can lead to the formation of blood clots that can travel to the brain and cause a stroke.

When Are Pacemakers Recommended for Atrial Fibrillation?

Pacemakers may be recommended for individuals with atrial fibrillation in the following scenarios:

1. Symptomatic Slow Heart Rate

If an individual with atrial fibrillation experiences a slow heart rate (bradycardia) that causes symptoms such as dizziness, fainting, or fatigue, a pacemaker may be recommended to help maintain a normal heart rate.

2. Unsuccessful Medication or Ablation

If other treatments, such as medications or catheter ablation, have been unsuccessful in controlling the heart rate or restoring a normal heart rhythm, a pacemaker may be considered as an alternative or complementary treatment option.

3. Atrioventricular (AV) Node Ablation

In some cases, a procedure called “AV node ablation” may be performed, where the electrical pathways between the upper and lower chambers of the heart are intentionally blocked. In these situations, a pacemaker is typically implanted to maintain a normal heart rate and rhythm.

What to Expect with Pacemaker Implantation for Atrial Fibrillation

The process of getting a pacemaker implanted for atrial fibrillation typically involves the following steps:

1. Evaluation and Planning

Your healthcare provider will thoroughly evaluate your condition, review your medical history, and determine if a pacemaker is the most appropriate treatment option for your specific case of atrial fibrillation.

2. Pacemaker Implantation

The pacemaker is typically implanted in a minor surgical procedure, during which a small incision is made in the chest, and the pacemaker is placed just beneath the skin. The procedure is generally considered safe and has a high success rate.

3. Follow-up and Monitoring

After the pacemaker is implanted, you will need to regularly follow up with your healthcare provider to ensure the device is functioning properly and to make any necessary adjustments to your treatment plan.

Potential Risks and Complications of Pacemakers for Atrial Fibrillation

While pacemakers are generally safe and effective, there are some potential risks and complications associated with their use, including:

1. Infection

As with any surgical procedure, there is a small risk of infection at the implantation site. Your healthcare provider will take steps to minimize this risk, and you will be given instructions on how to care for the incision site during the recovery process.

2. Lead Displacement

The leads (wires) that connect the pacemaker to the heart can sometimes become dislodged or displaced, which may require additional procedures to reposition or replace them.

3. Bleeding and Bruising

Some minor bleeding and bruising at the implantation site is common, but severe bleeding or hematoma formation is rare.

Conclusion

Pacemakers can play a valuable role in the management of atrial fibrillation, particularly in cases where other treatments have been unsuccessful or when complications such as slow heart rate need to be addressed. By working closely with your healthcare provider, you can determine if a pacemaker is the right treatment option for your specific case of atrial fibrillation.

How can pacemakers help with atrial fibrillation?

Atrial Fibrillation FAQs

View our short videos designed specifically to answer all your questions about Atrial Fibrillation

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Overview  |  Lifestyle Factors  |  Medications  |  Cardioversion  |  Catheter Ablation  |  Cryoballoon  |  Pacemaker  |  Elderly

Atrial fibrillation (AF or Afib) is a heart rhythm disorder that causes an irregular and sometimes fast heartbeat. You may experience no, mild, or severe symptoms, requiring treatments that target your various symptoms individually.

How do we treat atrial fibrillation?

Once we confirm your diagnosis and know the cause of your condition, we can recommend the most appropriate treatment. It’s also vital to manage any co-existing health conditions contributing to AF – such as diabetes or high blood pressure.

Atrial fibrillation treatments range from lifestyle changes and medications to cardiac devices and surgical procedures.  

With treatment, we aim to:

• Maintain a steady heart rate
• Restore your heart rhythm
• Reduce your stroke risk by preventing blood clots

We usually start your treatment plan with lifestyle changes and medications. However, we may recommend cardioversion, ablation, or a pacemaker if these are ineffective. 

Dr Syed Ahsan, our Consultant Cardiologist, has a wealth of experience in AF treatment. To discuss which treatment may benefit you, book an initial consultation today. Keep reading to learn more about AF treatments.

Lifestyle factors

While it is unlikely you can treat AF with lifestyle changes alone, they could help you manage your condition better alongside other treatments. A healthy diet, regular exercise, and quitting unhealthy habits, such as smoking and drinking alcohol excessively, can benefit people with Afib significantly. We also recommend limiting stimulants, such as coffee, tea, and chocolate. Nicotine itself is also a stimulant.

Your diet should be low in salt and fat and include many fresh fruits and vegetables. Adopting a Mediterranean diet may allow you more control over your blood pressure and blood sugar levels. We recommend monitoring your blood sugar, as people with AF are more likely to develop diabetes.

Our blog – Lifestyle changes to help manage arrhythmia – covers how these changes may help you in more detail.

Medications

Heart rate and rhythm control

We may prescribe beta blockers or an anti-arrhythmic to prevent your heart from:

• Beating fast
• Beating out of rhythm

You usually take these in tablet form and we’ll let you know whether you should take them with or without food. Though, there are a few side effects to note: worsening arrhythmia, nausea, cold hands/feet, low blood pressure, fatigue, constipation and nightmares. 

Preventing blood clots

Blood clots are a common complication of AF and strokes are five times more likely as a result. To avoid stroke we often prescribe:

• Blood thinners (such as warfarin) or 
• NOACs (non-vitamin K oral anticoagulants) (more commonly) 

You won’t need to watch your vitamin K intake with NOACs, as you would with medications such as warfarin.

Side effects of blood thinners include: indigestion, dizziness, heavy periods, easier bruising, muscle weakness and bleeding, such as bleeding gums

Cardioversion

You may be suitable for cardioversion if your AF is persistent or you do not respond to medications.

If you experience an abnormal heart rhythm, cardioversion can assist in restoring it with a small electrical shock. We do this via pads on the chest or back under a light general anaesthetic. 

The procedure is fast and safe, taking only a few minutes. Though, you may have a temporary rash on your skin caused by the pads. However, it isn’t a long-term treatment, and most patients will revert to AF eventually. 

We do not recommend cardioversion for patients with a blood clot in their heart. Cardioversion can cause these clots to loosen, leading to a stroke.

Catheter ablation

When symptoms are severe or medication isn’t sufficient or suitable, catheter ablation may be a feasible treatment. This is a minimally invasive surgical procedure that can noticeably improve AF symptoms, sometimes permanently.

We pass very fine catheters (wires) through a vein at the top of your leg and into the heart. You may experience some bleeding in these areas or bruising in the leg after the procedure. Electrodes at the tip of the wires then measure electrical signals within the heart and identify problematic areas. 

We then use radio-frequency waves transmitted via the wires to administer heat to the target area, stopping it from sending further AF signals to the heart. Watch our information video to learn more: What is catheter ablation?

Some people with atrial fibrillation also develop atrial flutter. Catheter ablation is the recommended treatment for atrial flutter.

Cryoballoon

An alternative to catheter (radio-frequency) ablation is the cryoballoon procedure. The procedure is performed similarly to catheter ablation. But, rather than delivering heat, it involves a ‘freezing balloon’ technology to prevent the signals that trigger AF from entering the heart.

You may experience bruising and bleeding after the procedure, similar to catheter ablation. You may also experience blood vessel or heart valve damage. To learn more about the differences, watch our video: What is the difference between cryoablation and radiofrequency ablation?

The cryoballoon technique may be more beneficial as it has a lower risk of re-ablation. It also involves a shorter procedure time. Paroxysmal atrial fibrillation, or PAF, causes intermittent AF symptoms. Cryoballoon is especially effective for these patients.

Pacemaker

If medications and other treatments for atrial fibrillation do not successfully maintain your heart rate, we may recommend a pacemaker. Some AF treatments may also cause a slow heart rate, such as ablation, requiring pacemaker treatment. 

A pacemaker procedure involves fitting a small implanted device close to your heart to regulate the heartbeat. Most people that need a pacemaker for AF are over 80. It is a safe procedure with a low complication rate, though there are some risks. These include blot clots in the arm on the same side of the pacemaker, a pacemaker infection, and an air leak.

There is also a minor chance that your pacemaker will malfunction. Signs of this include dizziness, feeling faint or fainting, and hiccups. Call your cardiologist if you think your pacemaker has malfunctioned.

Hybrid convergent procedure

If you have persistent AF or have previously had an ablation that didn’t work, a hybrid convergent procedure might help you. You can learn more about treatment options with this short video: What are my options if I’ve had atrial fibrillation for a long time?

The hybrid convergent procedure combines catheter ablation with surgery. This means that ablation can be performed on the inside and outside of the target area. It also allows the heart specialist to treat areas which are hard to reach with catheters.

The procedure can be completed in one go. Your surgeon might also suggest treating you in two sessions, at least a month apart. Dr Ahsan helped develop this technique and is a leading expert in performing it. To learn more, and find out if it’s right for you, contact the London Heart Clinic today.

Treating atrial fibrillation in the elderly

Atrial fibrillation risk increases with age, particularly after 65. For elderly patients, our first focus is controlling the heart rate. Many older patients experience no symptoms of AF. These people often benefit from anti-arrhythmics. 

Elderly patients are more likely to experience conditions that contribute to AF, which we need to manage. We will likely recommend blood-thinning medications as stroke risk also increases with age. The catheter ablation procedure involves more risk, though it is still possible.

Book an appointment

This page offers a brief overview of how we treat atrial fibrillation and what each treatment involves. For a more in-depth view of AF treatments, read our patient guide: What is the treatment for atrial fibrillation?

If you suspect or are experiencing atrial fibrillation, our Consultant Cardiologist, Dr Syed Ahsan, can recommend the most appropriate treatment. Book a private consultation today to get started.

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Get in touch or book an appointment to discuss how London Heart Clinic could help.

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Pacemaker as Treatment for Atrial Fibrillation

Written by Steven Brown

• Atrioventricular (AV) Node Ablation
• Sick Sinus Syndrome
• Living With a Pacemaker
• Dos and Don’ts

If you have atrial fibrillation (AFib), that means something’s not right with the electrical signals that trigger your heartbeat. The four chambers inside your heart get out of sync as they pump your blood. Your doctor may use prescription drugs or a medical procedure to try to make your heart beat regularly or slow down a fast rhythm.

But if you have AFib and your heart is beating too slowly, your doctor may recommend a pacemaker along with other treatment. It sends out electrical pulses that take the place of the mixed-up ones, so your heart beats at the right pace.

You also might need a pacemaker if you have AFib and congestive heart failure. That’s when your heart can’t pump enough blood to the rest of your body the way it should.

If medication or other treatments haven’t worked, your doctor might recommend this procedure, which stops the irregular electrical pulses from getting to your heart’s two lower chambers, called the ventricles.

Your medical team will put a thin tube called a catheter into your heart. It will fire off intense radio waves, and the heat will destroy the small area that carries the signals to the ventricles. That area is called the AV node.

Afterward, your heart’s natural electrical system won’t be able to trigger your ventricles. So your surgeon will put in a pacemaker to tell the ventricles when it’s time to pump.

Even with this treatment, your heart’s two upper chambers, called the atria, will still have AFib. That can raise your chances of a stroke, because your blood may form clots that could travel to your brain. You’ll probably need to take a blood thinner to keep the blood from clotting.

This condition has nothing to do with the sinuses in your head. The name refers to a small part of your heart called the sinus node. It’s your heart’s natural pacemaker. It generates the electrical pulses that tell your heart to beat. When the sinus node fires off the signals at the wrong pace, your heartbeat can be too fast (tachycardia), too slow (bradycardia), or irregular (arrhythmia). It can lead to abnormal heart rhythms, including AFib.

Most people who have sick sinus syndrome need a pacemaker. The type that’s most likely to help is called a double chamber pacemaker. It sends signals to two of your heart’s four chambers, telling them when to pump.

Your doctor would put the pacemaker under your skin near your collarbone during minor surgery.

If you have AFib and get a pacemaker to help treat a slow heart rate or congestive heart failure, it might help in other ways, too:

• It can tell your doctor what’s going on in your heart when you change medicines or have a medical procedure.
• It might ease AFib symptoms when you have them.
• Researchers are studying whether a pacemaker could help stop AFib from coming back.

When you have a pacemaker, you need to do your part, too:

• Keep track of your heart rate. Your doctor will give you guidelines about how fast or slow your heart should beat and how that matches up with your pacemaker. Check your pulse as often as you’re instructed to. If your heart rate goes outside that range, call your doctor.
• Take all your medications on schedule.
• Stay active. Go for walks or do whatever you enjoy. Your medical team can help you decide how much exercise is right for you.
• Don’t put pressure on the part of your chest where the pacemaker is.

Meanwhile, watch for any signs that your pacemaker isn’t working right. Call your doctor right away if your ankles swell. Call 911 if you have a hard time breathing, are dizzy, or if you fainted.

A pacemaker is a sensitive electronic gadget. If you get one, here are a few things to remember so other electrical devices can’t mess it up.

• Home appliances generally don’t bother a pacemaker. It’s OK to microwave your lunch, use a vacuum cleaner, or sleep under an electric blanket.
• Your cell phone may not cause any problems. But to be safe, hold it on the side of your head opposite from your pacemaker.
• MP3 player headphones may have a magnetic piece that could throw off your pacemaker. Keep them a couple of inches away from it. Don’t put the headphones into your shirt pocket or hang them around your neck.
• Metal detectors that you walk through at security checkpoints could affect your pacemaker, so go through them as quickly as you can. If security personnel want to check you with a handheld wand, tell them you have a pacemaker. They shouldn’t hold the wand near the pacemaker for any length of time.

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Publication date
01/10/2023

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Depending on age and health, the ideal resting heart rate for an adult is between 60 and 100 beats per minute. As a general rule, the lower the resting heart rate, the better. However, in some cases, an irregular, too slow, or too fast pulse can lead to complications. An irregular heartbeat, known as an arrhythmia, occurs when the electrical signals that coordinate the heart’s beats don’t work properly. An arrhythmia is one of the reasons you may need a pacemaker. While not all heart conditions can be treated with a pacemaker, there are signs that it is necessary. Below, our cardiologists talk about the most common signs that you need a pacemaker.

What is a pacemaker and what does it do?

With advances in medical technology, cardiologists have gained a better understanding of how the heart works, allowing them to develop and create multiple treatment options to effectively control irregular heartbeats. As a result, modern pacemakers, used to treat arrhythmias and disease states, can safely prolong your life and greatly improve its quality.

A pacemaker is a small device that is implanted in the chest just below the collarbone to help control the heartbeat. During the pacemaker procedure, small wires are inserted into the heart, the ends of which are connected to the heart muscle. The other ends are connected to the pacemaker unit. When the device senses an abnormality, it sends electrical signals through the electrodes to your heart, causing it to start beating again. Pacemakers work only when needed and can be programmed to work during episodes of bradycardia, atrial fibrillation, or cardiac arrest.

Types of pacemakers

Depending on your condition, you may have one of the following types of pacemakers:

• Single chamber pacemaker – transmits electrical impulses to the right ventricle of the heart.
• Dual chamber pacemaker – delivers electrical impulses to the right ventricle and right atrium of the heart to control the timing of contractions between the two chambers.
• Biventricular Pacemaker – A pacemaker for those with heart failure or palpitations. It stimulates both lower chambers of the heart to make the heart beat more efficiently.

An arrhythmia can be silent, meaning you don’t notice any symptoms, so it’s best to have the correct diagnosis made by your doctor during a physical examination. Symptoms of an irregular heartbeat may include:

• Chest flutter
• Palpitations
• Slow heartbeat
• Chest pain
• Shortness of breath
• Anxiety
• Fatigue
• Slight dizziness or dizziness
• Sweating
• Fainting or near-fainting state

When is a pacemaker needed?

PCMC cardiologists are experts in identifying heart conditions that would benefit from a pacemaker. Symptoms that may indicate the need for a pacemaker include:

• Extreme fatigue
• Dizziness or feeling dizzy
• Palpitations or fluttering sensation of the heart
• Muscle weakness in arms and legs
• Shortness of breath, labored breathing or chest pain
• Unexplained syncope
• Confusion
• Pulse rate less than 90

If you have any of these symptoms, you should have an additional cardiac evaluation with your doctor who will recommend the best treatment plan for you.

Comprehensive Cardiovascular Care at PCMC

Whether you have symptoms of an irregular heartbeat or want to make an appointment with a preventive cardiologist, PCMC has doctors with vast experience in cardiovascular disease management who set the standard for prevention , offering the latest medicines and procedures for the treatment of heart disease. Contact us by phone or leave a request on the website to make an appointment with our doctors.

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Pacemaker | effective treatment of arrhythmia

The heart has an internal electrical conduction system that controls the heart rate. Each contraction of the heart is created by the passage of an electrical impulse from the top of the heart to the bottom. The passage of this electrical impulse causes the heart muscle to contract and pump blood. For the heart to function properly, the heart rate must be within the normal range, that is, not too fast or too slow, but in a regular rhythm of approximately 70 beats per minute.

Arrhythmias and pacemakers

A pacemaker is a small device for treating abnormal heart rhythms that is implanted in a patient’s chest or abdomen. Heart rhythm disorders, or arrhythmias, include conditions in which the heart beats too slowly (bradycardia), too fast (tachycardia), or irregularly.

During cardiac arrhythmias, cardiac output may be affected and cause symptoms such as fatigue, shortness of breath, general weakness. The arrhythmia can cause damage to various vital organs of the body, due to a significant decrease in cardiac output, and in extreme cases can lead to loss of consciousness and even death.

A pacemaker helps to regulate the heartbeat and relieve the symptoms of cardiac arrhythmia, and in many cases return the person to normal activities.

Who needs a pacemaker?

The most common conditions requiring a pacemaker are conditions of slow heartbeat (bradycardia) or a disorder in the electrical conduction system of the heart (heart block). In such cases, the electrical impulse is produced too slowly by the heart, or the propagation of the impulse to all parts of the heart is disrupted. Such conditions can be caused by advanced age, damage to the electrical conduction of the heart as a result of myocardial infarction, or other diseases that affect the conduction system of the heart.

The decision to use a pacemaker is made by the attending physician according to the degree of arrhythmia in the patient, the patient’s symptoms and heart rate, and the results of additional diagnostic tests (ECG, Holter monitoring, echocardiography, stress testing, electrophysiological testing, and others).

How does a pacemaker work?

The pacemaker consists of a battery, a computerized generator and sensitive leads called electrodes. Batteries and a computerized generator are assembled into a single unit in a metal box, with electrodes connecting the generator unit to the patient’s heart. The pacemaker is connected to electrodes placed in different cavities of the heart.

The pacemaker helps control the heart rate by using electrodes that sense the natural electrical activity of the heart and send information to a computer device in the pacemaker generator. If the heart rate becomes unacceptable (for example, too slow), the computer instructs the generator to send an electrical impulse to the heart through the electrode.

The pacemaker can detect the patient’s blood temperature, respiratory rate and mobility and adjust the rhythm according to the physiological needs of the body. The programming of the pacemaker is carried out using an external device, without the need for direct contact with the pacemaker.

Pacemaker implantation process

The transplant operation is performed in a sterile room, usually under local anesthesia in the transplant area only, with light sedation.

First, the doctor makes an incision up to 5 cm in the upper chest and prepares a place under the skin for the pacemaker. By inserting a conductor into a large vein, the doctor advances the electrode through the vein to the patient’s heart and places the electrode, controlling the actions in the appropriate place using a visual diagnostic system (X-ray), showing the doctor the exact location of the electrodes in the patient’s body immediately during the operation.

The other end of the electrode is then screwed into the pacemaker and the entire system is inserted into the pre-prepared area under the skin. The incision is closed with stitches or staples. The procedure takes about two hours.

Pacemaker

The recovery process after surgery is relatively fast. A few hours after implantation, the patient can get out of bed and walk around the room. As a rule, the patient stays in the hospital for one more day for observation.

A few days after transplantation, there may be slight pain, slight swelling and tenderness in the area of ​​the implant. Usually, taking painkillers is enough to relieve pain.

It is necessary to avoid getting water on the graft area for a week, refrain from raising the arm above shoulder level and heavy work for a month.

Most patients return to normal activities a few days after implantation.

Pacemaker

In most cases, the fact that the patient is a pacemaker carrier does not limit strenuous exercise or sports activities. However, contact sports, which can damage the pacemaker and electrodes, should be avoided.

A patient with a pacemaker should avoid direct and prolonged contact with electrical appliances or devices that have a strong magnetic field induction, which may affect the normal functioning of the pacemaker. These include: cell phones, MP3 players, household appliances such as microwave ovens, metal detectors, electric welding or electric generators. These devices can interfere with the electrical impulse from the pacemaker and prevent the device from working properly.

It is recommended that you do not put your mobile phone or MP3 player in your pocket above the pacemaker, and be aware that the pacemaker may not function properly. Simple rules should be followed:

• put your mobile phone on the ear opposite the pacemaker.
• do not stay near and for a long time near electrical appliances, with a strong induction of the magnetic field
• at the airport it is necessary to inform the security guard that you are wearing a pacemaker in order to reduce the time of the metal detector check and not to conduct it over the heart area
• keep at least 50 cm away from electrical generators and welding machines.

Before starting any treatment, you should inform your doctor about the presence of a pacemaker, because sometimes, treatment requires making some changes to the pacemaker program before the planned medical operation in order to prevent damage to it during the procedure.

Pacemaker Innovation – Pacemaker Approved for MRI Testing

MRI is becoming more and more common diagnostic procedure. In many cases, MRI is a very important and necessary imaging test for diagnosing and monitoring a specific disease. Since this test involves the use of the most powerful electromagnetic fields, there is a risk of damage to the pacemaker and electrodes, as well as internal tissues due to heating or displacement of the pacemaker components.

Thus, there has been a need to develop entire pacemaker systems that allow MRI, and a breakthrough in this field was recently made when pacemaker systems were developed that allow MRI testing of all parts of the body, without restrictions.

However, younger patients who are thought to be more likely to need an MRI in the future, or patients with a disease that requires MRI monitoring, will receive a pacemaker that allows this examination, the so-called MRI compatible pacemaker.

Medical monitoring

Your doctor will check your pacemaker regularly for 3 to 12 months after your transplant. The test is usually carried out in a clinic. The integrity of the pacemaker system, the condition of the battery of the device, whether the rhythm and sensitivity of the electrodes are normal, whether there is a need to redistribute and reprogram the device to a different rhythm, and whether there is a need to make changes to the patient’s drug treatment are checked.

Pacemaker replacement due to depleted batteries is performed on average once every 6-8 years. Replacing a generator or battery involves a small operation, often without the need to replace the electrodes.

Remote Monitoring of Pacemaker Transplant Patients

Telemedicine systems for monitoring and remote monitoring are now available for pacemaker and defibrillator patients.