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  • Q&A with Australian Health Practitioners

    How does a pacemaker control atrial fibrillation?

    Related Topics
    Atrial Fibrillation Cardiology & Vascular Health
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    Dr Michael Davis

    Cardiologist (Heart Specialist)

    Electrophysiologist and pioneer in catheter ablation and in the management of atrial fibrillation. Expertise in arrhythmia device therapy, coronary care, echocardiography. View Profile

    A pacemaker cannot “control” atrial fibrillation. Pacing the atrium can in some cases reduce the chance of atrial fibrillation particularly where there is sinus node dysfunction or in combination with antiarrhythmic drugs which might otherwise not be employable because they cause slow heart rates.

    If the ventricular rate (pulse rate) cannot be adequately controlled with medication in someone who is permanently in atrial fibrillation one option is to implant a pacemaker and then ablate (destroyed using radiofrequency energy delivered through a catheter) the AV node. This prevents the rapid conduction of the atrial fibrillation to the ventricle. The heart usually has a slow regular escape rhythm with the pacemaker bringing this up to an acceptable rate which can be programmed to increase responsive to a person's needs.

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    Dr Shakeeb Razak

    Cardiologist (Heart Specialist)

    Dr. Shakeeb Razak completed his undergraduate medical training at the University of Western Australia and his postgraduate cardiology training at Royal Perth Hospital. He undertook … View Profile

    There is a common misunderstanding that a pacemaker implantation alone will  “control” atrial fibrillation. This is untrue.

    In patients with rapid heart rates with atrial fibrillation that can't be controlled with maximum medication, a “pace and ablate” approach is most useful. This involves implanting a pacemaker first and then ablating the AV node (which destroys the AV node using radiofrequency energy and heat delivered through an ablation catheter). This is performed several weeks following pacemaker implantation to ensure that the pacemaker and leads are functioning well.  

    The AV node ablation procedure stops the rapid conduction of the atrial fibrillation to the ventricle. Following ablation, the heart usually has a slower regular escape rhythm. In conjunction with the pacemaker, this allows very tight control of a person's heart rate. The heart rate can then be easily programmed to range from a lower rate of ~60-70bpm up to higher rates ~120-130bpm to allow a person's heart rate to meet the needs of the individual during various activities.  

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