Will I Need a Pacemaker for My Atrial Fibrillation?

Medically Reviewed by Smitha Bhandari, MD on August 29, 2022
4 min read

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.