If your doctor has recommended a pacemaker, it’s important to understand how this compact piece of technology works with medication for successful afib treatment. Pacemakers are used most often for atrial fibrillation when someone’s heart rate switches between fast and slow rhythms. “This is called tachy-brady syndrome,” says Dhanunjaya Lakkireddy, MD, an electrophysiologist at the University of Kansas Hospital in Kansas City, Kan. The heart beats too fast in atrial fibrillation and too slow when it’s not. You may also need a pacemaker for atrial fibrillation if your medication slows your heart rate too much. “Pacemakers stabilize a slow heart rate and allow your doctor to use medications to control the afib,” Dr. Lakkireddy says. Age can also be a factor. “For an elderly afib patient, a pacemaker may be inevitable,” says Lakkireddy. “If a patient’s internal electrical system is not as robust as it needs to be, a pacemaker makes sense.”
How Pacemakers for Afib Work
A pacemaker “listens” to your heart and keeps track of your heartbeat. If it senses that your heart is beating too slowly or too quickly, it sends electrical impulses that prompt your heart to beat at a normal pace. The metal device is about the size of a silver dollar and is surgically implanted under the skin near your collarbone. The pacemaker holds a battery and a tiny computer, and it has wires that connect it to your heart.
How Pacemakers Help Atrial Fibrillation
When you have atrial fibrillation, your doctor has two goals: to get your heart rate under control and to prevent a stroke. “Pacemakers will not cure atrial fibrillation, but they allow us to give the patient medications to slow the heart down,” says Ashish Pershad, MD, an interventional cardiologist at Banner Good Samaritan Medical Center in Phoenix. “A patient with a pacemaker is still at risk for stroke, but they can now take the medications they need.” Pacemakers can also relieve some afib symptoms. “You’ll no longer feel a racing heartbeat,” says Dr. Pershad. Dizziness, shortness of breath, and general fatigue may also be eased.
What to Expect from Pacemakers for Afib
Implanting a pacemaker requires minor surgery and usually an overnight stay in the hospital. During the procedure, your surgeon will insert a needle into a large vein near your collarbone and use the needle to thread the pacemaker wires into the vein, Pershad explains. With the help of X-ray images, the surgeon guides the wires to your heart. Once the wires are in place, the surgeon will make an incision below your collarbone to create a small pocket for the pacemaker, place the pacemaker’s small metal box into the pocket, and connect it to the wires that lead to your heart. “In most cases a pacemaker is permanent,” says Pershad. Your doctor will work with you to help you manage your pacemaker and adjust your medications.
Risks of Pacemakers for Atrial Fibrillation
Pacemaker surgery is generally safe. “The risks are very low,” says Pershad. “Most people are out of the hospital the next day and can return to normal activities after a few weeks.” Complications are rare but may include:
Infection in the area where the pacemaker was placedBlood vessel or nerve damageA punctured lung during the process
“It’s important to remember that pacemakers are not a stand-alone treatment for atrial fibrillation,” says Lakkireddy, “but they can be effective in some cases.” After your pacemaker is put in, continue to work closely with your doctor to control your afib and reduce your risk for blood clots, stroke, and heart failure.
