Living with AFib: How pacemakers can improve quality of life

Atrial fibrillation, or AFib, is the most common type of heart rhythm disorder. The Centers for Disease Control and Prevention estimate about 12 million people in the United States will have AFib by 2030.

For many patients, a pacemaker device can help manage these irregular heart rhythms, or arrhythmias. Antonio Navarrete, MD, clinical cardiac electrophysiologist and director of the Cardiac Electrophysiology Lab at IU Health Saxony Hospital, discusses when patients may benefit from a pacemaker for AFib.

What is AFib?

AFib describes an irregular heartbeat that’s unusually fast. This condition begins in the upper heart chambers and affects how blood flows through the heart.

“AFib takes over the normal pacemaker cells in the heart and decreases how well the heart pumps,” Dr. Navarrete said. “AFib can lead to heart failure, and it can also increase your stroke risk fivefold because it creates stagnant blood flow.”

Common symptoms of AFib include:

• Heart palpitations, or irregular heart beats
• Shortness of breath
• Heart pounding sensations or flip-flop feelings
• Fatigue or fainting

“Some patients may experience vague symptoms, such as fatigue, or they may not show any symptoms at all, which can delay a diagnosis and potentially lead to a stroke,” Dr. Navarrete said.

When you need a pacemaker to treat AFib

There are many heart conditions that can be treated with pacemakers. If you are experiencing the symptoms above, your primary care physician may refer you to an electrophysiologist or cardiologist to evaluate your heart. This physician will ask detailed questions to understand your medical history, and may order tests, such as a heart monitor or echocardiography, which capture images of the heart.

“Physicians may consider a pacemaker for patients experiencing symptoms such as fatigue, tiredness, light-headedness, passing out, a lack of heartbeats for several seconds, or even rapid heart rates,” Dr. Navarrete said.

How pacemakers help manage AFib

A pacemaker is a small, electric device implanted into the chest or directly into the heart muscle that sends electrical signals, or pulses, into your heart to regulate its rhythm. There are several different types of pacemakers, depending on your heart’s needs. The procedure to place a pacemaker can be done in the outpatient setting under sedation. Patients receiving a leadless pacemaker can quickly resume normal activities and drive within a couple of days of the procedure. Patients receiving a conventional pacemaker (with wires) can drive within one week.

“While pacemakers are not a cure for AFib, they can effectively manage irregular heartbeats, in combination with medications,” Dr. Navarrete said.

Treating atrial fibrillation requires individualized care that depends on your specific needs and can include one treatment or a combination of therapies. AFib can be controlled with medications alone, a pacemaker combined with medications, or through a procedure called a catheter ablation, which targets the root cause of the arrhythmia. During this minimally invasive procedure, your doctor uses a hot or cold energy source to destroy the cells in your heart that are causing the arrhythmia. A small number of patients who undergo catheter ablation may also require a pacemaker, but it depends on individual needs.

“Catheter ablation is specifically aimed at managing AFib overall. But a small proportion of patients with AFib will experience prolonged cardiac pauses that could lead to a loss of consciousness. For this group, a pacemaker is essential to prevent fainting episodes,” Dr. Navarrete said. “Pacemakers may also be used to tolerate higher doses of medication to control fast heart rates. In this way, the pacemaker supplements the medication.”

Experiencing AFib with a pacemaker

Patients often do not feel the pacemaker device at work in their chests, but it is common to feel a new sensation when the pacemaker corrects an arrhythmia. The batteries in a pacemaker last five to 12 years, and the entire device will be replaced in an outpatient procedure similar to your initial pacemaker placement. You will check in regularly with your physician and oftentimes, these checks can be done remotely.

“Patients using a pacemaker are often surprised by the convenience of remote cardiac checks, in which we can monitor a patient’s pacemaker from home in real time. This is convenient and helps reduce hospital visits,” Dr. Navarrete said.

A pacemaker could be right for you

AFib is a common heart condition with a variety of treatment options. If you’re concerned about an irregular heartbeat, contact your physician to discuss any concerning symptoms and how best to address them.