Pacemaker for Atrial Fibrillation

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Pacemaker for Atrial Fibrillation

Treatment Overview

A pacemaker is a battery-powered device about the size of a pocket watch that sends weak electrical impulses to “set a pace” so that the heart is able to maintain a regular heartbeat. Some people who have atrial fibrillation need a pacemaker.

There are two basic types of pacemakers.

  • Single-chamber pacemakers stimulate one chamber of the heart, either an atrium or more often a ventricle.
  • Dual-chamber pacemakers send electrical impulses to both the atrium and the ventricle and pace both chambers. A dual-chamber pacemaker synchronizes the rhythm of the atria and ventricles in a pattern that closely resembles the natural heartbeat.

All new pacemakers are rate-response, or physiologic, pacemakers. They can sense when your activity increases and respond by increasing your heart rate.

Permanent pacemakers are surgically implanted into the chest. The procedure to implant a pacemaker is considered minor surgery. It can usually be done using local anesthesia. The procedure takes about an hour. Permanent pacemakers are powered by batteries. The batteries usually last 5 to 15 years before they need to be replaced.

Temporary pacemakers are attached to the heart by a wire threaded through a neck vein, a leg vein, or through the chest wall. Temporary pacemakers are most commonly used for a short time following heart surgery or when waiting for a permanent pacemaker to be implanted.

What To Expect After Treatment

Most people stay overnight in the hospital after they have a pacemaker implanted. And they typically go home the next day. But sometimes the surgery is done as an outpatient procedure, which means you do not need to stay overnight in the hospital.

Most people return to normal activities after a few weeks. For several weeks after having a pacemaker implanted, avoid driving or doing vigorous physical activity that involves the upper body.

About twice a year your doctor will check your pacemaker and adjust it, if needed.

Why It Is Done

People with atrial fibrillation may need a pacemaker for a variety of reasons. These reasons include:

  • You have atrial fibrillation that comes and goes. And you have a fast heart rate when you are in atrial fibrillation and a slow heart rate when you are not in atrial fibrillation. This is called tachy-brady syndrome.
  • You had a catheter ablation procedure that destroyed the AV node in your heart. This AV node helps control your heart rate. A pacemaker is placed to control the heart rate.
  • You have a problem with the natural pacemaker of the heart (AV or SA node).
  • You take a medicine for atrial fibrillation that slows your heart rate too much.

How Well It Works

Pacemakers stimulate the heart to speed up when it beats too slowly or reset the rate when the heart beats too fast. They can also substitute for the natural pacemaker of the heart (AV or SA node).


Few activities interrupt the signals sent by the pacemaker to the heart. Follow your doctor's specific instructions about care and precautions if you have a pacemaker.

Risks during the procedure to implant a pacemaker include:

  • Puncture of the heart.
  • Bleeding.
  • Difficulty breathing.
  • Irregular heart rhythms.
  • Infection.
  • Blood clot.
  • Pacemaker malfunction (wire breaks or device has sensing problems).

What To Think About

In rare cases, people feel throbbing in the neck, chest fullness, or light-headedness when the pacemaker sends out impulses. Talk to your doctor about what types of side effects you may expect from your pacemaker.

Rate-responsive pacemakers are often the ideal choice for active people. These pacemakers closely reproduce natural heart rhythms and are able to raise heart rate in response to physical activity. Your doctor can decide how fast the pacemaker should respond and how quickly your heart rate should return to a resting rate.

Strong electric or magnetic fields can interfere with your pacemaker. You can safely use most household and office equipment. And you can usually avoid electrical interference from magnetic or electrical sources by keeping certain things a few inches away from your pacemaker. You should completely avoid things like heavy electrical or industrial equipment.

You may walk through metal detectors (in airports or other security checkpoints) at a normal speed. But avoid standing near or leaning on these systems. Your pacemaker may set off a metal detector, but the security archways will not damage the device. Your doctor will give you a pacemaker identification card to carry at all times. Before you pass through a metal detector, tell the security guards that you have a pacemaker, and show them your device identification card.

If you have a pacemaker, you will not be able to have an MRI (magnetic resonance imaging) test. Before you have any tests or surgery, tell all of the health professionals involved in your care that you have a pacemaker. You may choose to wear a medical alert bracelet that says you have a pacemaker. Experts are trying to make pacemakers that can work safely during an MRI test.

Click here to view an Actionset. Heart Problems: Living With a Pacemaker or ICD

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By Healthwise Staff
Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
Primary Medical Reviewer Brian D. O'Brien, MD - Internal Medicine
Specialist Medical Reviewer John M. Miller, MD - Electrophysiology
Last Revised February 14, 2011

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