Pacemakers and Atrial fibrillation

Sometimes patients with Atrial Fibrillation can also have an abnormally slow ventricular heart rate, often called Bradycardia. Not all patients with Atrial Fibrillation have a slow heart rate, but if you do, your doctor might recommend you have a pacemaker implanted. A pacemaker is designed to monitor and treat your abnormal heart rhythm. 

Most pacemakers are small machines with two parts:

• A small, metal battery-operated computer sometimes called a Pulse Generator that is typically implanted in the into soft tissue beneath the skin in the chest.
• Wires (leads/electrodes) that are implanted in your heart and connected to the Pulse Generator.

Bradycardia is an abnormally slow heartbeat, fewer than 60 beats per minute. If the chambers of your heart don’t contract often enough to supply enough blood, your body doesn’t get enough oxygen and nutrients to function properly. As a result, you may feel tired or dizzy, have shortness of breath or have fainting spells. A pacemaker stimulates your heart with electrical impulses to restore a normal rhythm.

The pacemaker continuously monitors your heartbeat and delivers electrical energy (as programmed by your physician) to pace your heart if it’s beating too slowly. 

Your pacemaker also stores information about your heart. This allows your doctor to better evaluate the therapy and adjust your pacemaker settings, if necessary.

Pacemakers help to regulate your heart rhythm, ensuring that your heart pumps the required amount of blood through your body to help with oxygenation and nutrient delivery. The main benefits of a pacemaker include:

• Relieving symptoms caused by heart rhythm problems, such as chest pain, confusion, palpitations, nausea, and fainting.
• Preventing symptoms like fainting that are caused by arrhythmias.
• Coordinating heart beats to improve heart function.
• Providing more energy and less shortness of breath for individuals with bradycardia.

There are some risks associated with having a pacemaker inserted, including:

• Bleeding or infection where the pacemaker and leads were placed.^1,2,3
• Swelling, bruising or bleeding^1,2,3
• Blood clots near where the device has been placed
• Damage to blood vessels or nerves near to where the device has been implanted.

Implanting a pacemaker system requires a minor procedure in the upper chest, under the skin. Most people go home within 24 hours. Your doctor will provide specific guidelines based on your health status. Here is a general outline of what to expect. 

Before the procedure:

If you and your doctor have decided on pacemaker implantation, here’s how you may prep for your procedure.

• You may be asked not to eat or drink anything for a period of time before your procedure. Ask your doctor for specific instructions
• Your doctor will advise which medications to stop or start taking before your procedure and for how long
• Wear comfortable clothes to your procedure with a possible change to wear home. Your doctor will give you specific instructions

During the procedure:

For the implantation, you will be sedated. Your doctor will insert a lead in a vein near your collarbone using a small incision. The lead is passed through the vein to the heart where your pacemaker is inserted beneath the skin. Before closing the incision, your doctor tests the pacemaker to ensure it is working properly. 

Following pacemaker insertion, many patients feel an improvement in symptoms caused by a slow heart beat including more energy, less tiredness, improved or resolved lightheadedness and fainting. Many patients report a more active lifestyle as a consequence of improved symptom management. Your health care professional will discuss regular check ups with you and your options for remote monitoring. 

Learn more about pacemakers in the management of atrial fibrillation.