The role of pacemakers in the prevention of atrial fibrillation
- Rod Passman, MD, MSCE
Rod Passman, MD, MSCE
- Professor of Medicine
- Northwestern University Feinberg School of Medicine
The principal reason to place a pacemaker in a patient with atrial fibrillation (AF) is to treat symptomatic bradycardia. Pacing has not been shown to prevent the development of AF.
This topic will review the role of pacemakers in the prevention of AF. Brief mention will be given to implantable cardioverter defibrillators. The utility of other nonpharmacologic strategies for preventing AF is discussed separately. (See "Catheter ablation to prevent recurrent atrial fibrillation: Clinical applications" and "Surgical approaches to prevent recurrent atrial fibrillation".)
PATIENTS WITHOUT AN INDICATION FOR A PACEMAKER
In patients with a history of atrial fibrillation (AF), pacing from one or both atria has been suggested as a means to reduce AF recurrences. There is no conclusive evidence to support the implantation of an atrial pacemaker to prevent AF in patients who do not have an indication for pacing; symptomatic bradycardia is the most important group . Similar to societal guidelines, we do not recommend the insertion of an atrial pacemaker for this purpose . (See 'Overdrive (antitachycardia) atrial pacing' below.)
PATIENTS WITH SYMPTOMATIC BRADYCARDIA
Many patients with atrial fibrillation (AF) have sick sinus syndrome with symptomatic bradycardia requiring pacemaker placement. The appropriate pacing modes for patients with sick sinus syndrome are discussed separately. (See "Treatment of the sick sinus syndrome", section on 'Treatment'.)
In patients who require permanent pacing, only physiologic pacing from the right atrium has been shown to prevent episodes of AF.
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- PATIENTS WITHOUT AN INDICATION FOR A PACEMAKER
- PATIENTS WITH SYMPTOMATIC BRADYCARDIA
- Physiologic pacing
- Alternate strategies of atrial pacing to prevent recurrent AF
- - Alternative-site, dual-site right atrial, and biatrial pacing
- - Impact of site and rate of atrial pacing
- - Overdrive (antitachycardia) atrial pacing
- PATIENTS WHO REQUIRE ICD OR RESYNCHRONIZATION THERAPY
- MAJOR SOCIETY GUIDELINES
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS