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The role of pacemakers in the prevention of atrial fibrillation

Rod Passman, MD, MSCE
Section Editor
Bradley P Knight, MD, FACC
Deputy Editor
Gordon M Saperia, MD, FACC


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 ablation to prevent recurrent atrial fibrillation".)


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 with a history of AF but no indication for pacing [1]. Similar to societal guidelines, we do not recommend the insertion of an atrial pacemaker for this purpose [2]. (See 'Overdrive (antitachycardia) atrial pacing' below.)


Many patients with atrial fibrillation (AF) have sick sinus syndrome with symptomatic bradycardia requiring pacemaker placement. Moreover, antiarrhythmic drug treatment may lead to sinus or atrioventricular nodal dysfunction that may require pacing in order to permit up-titration of drug dose. The appropriate pacing modes for patients with sick sinus syndrome are discussed separately. (See "Sick sinus syndrome: Treatment", 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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Literature review current through: Nov 2017. | This topic last updated: Sep 07, 2017.
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