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August 03, 2022

The heart of the matter: Pros and cons of pacemakers for AFib

IU Health Bloomington Hospital

The heart of the matter: Pros and cons of pacemakers for AFib

The heart is essential for dancing, singing, and more. But what happens when your heart is the thing that won’t stay on-beat?

Pacemakers are tiny machines that use electrical signals from batteries to stimulate your heart when it doesn’t beat fast enough.

The two types of pacemakers available have pros and cons, so it’s always best to talk to your cardiologist about what fits you and your needs best.

Type one: traditional

The traditional pacemaker has a small housing unit for the battery surgically placed in the patient’s upper chest in a pocket over the muscle, but under the skin and soft tissue. Electrode leads are attached to the unit and travel through your veins to one or more chambers of your heart.

“The traditional pacemaker is the go-to option for atrial pacing, and in some other more specific clinical scenarios,” says IU Health Southern Indiana Physicians Electrophysiologist Kyle Hornsby, MD. “There are some risks, as with any medical procedure, but pacemakers have been helping extend lives for the past several decades and have helped hundreds of my patients have more time to spend with their loved ones.”

Type two: leadless

Leadless pacemakers are a newer option implanted directly into the heart muscle.

“One advantage of the leadless device is you don’t have the pocket, which can be a source of infection, bleeding, and hematomas,” says Hornsby. “No leads also means we don’t need to worry about the additional surface area within the veins that can be affected by traditional pacemakers.”

He explains that the electrodes (leads) have to travel through veins to reach the heart and can require extraction if they break or malfunction, and they have an increased risk for bacterial infection. Also, leadless pacemakers preserve veins that may be needed for medical issues, including dialysis or central venous access.

As you can imagine, the leadless pacemakers are tiny since they have to fit within one chamber of the heart called the right ventricle—and a human heart is only about the size of your fist.


Cardiology specialists consider everything they know about their patients when deciding if they need a pacemaker and which type is best for those needing one.

You need to know when to talk to the heart doctors to find out if you would benefit from these rhythm machines.

Symptoms that you should pay attention to include:

  • Fatigue
  • Shortness of breath (both at rest and with exertion
  • Lightheaded spells
  • Passing out
  • Swelling of the legs and fluid retention with acute weight gain

“Those are all good indications that you need to speak to a cardiologist more urgently and seek medical attention,” says Hornsby.

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