A pacemaker isn’t typically considered a treatment for AFib unless you have AFib with a slow ventricular rate. In this instance, a pacemaker can make sure your heart rate doesn’t drop below a specified setting.

A pacemaker is an implantable device that helps your heart beat at a normal rate. Experts estimate up to 3 million people in the United States may have a pacemaker.

If you have an arrhythmia, your doctor may recommend a pacemaker. One type of arrhythmia that a pacemaker can treat is atrial fibrillation (AFib) with a slow ventricular rate.

Your doctor may also recommend you get a pacemaker if you have other irregular heart rate issues, such as tachycardia, which is a heart rate that’s too fast.

Keep reading below to learn what types of AFib pacemakers may treat, the ideal candidates for a pacemaker, and the risks associated with implanting a pacemaker.

In AFib, abnormal electrical signaling in the upper chambers of the heart, called the atria, leads them to beat irregularly and often quickly.

When this happens, the upper and lower chambers of the heart cannot work together properly, meaning your heart pumps blood less efficiently.

The overall goal of a pacemaker is to restore a normal heart rate. To do this, the pacemaker sends small electrical signals to your heart tissue.

A pacemaker can help your heart pump blood more effectively. It can also prevent complications from arrhythmia.

If you have AFib, there are some situations where a doctor may recommend a pacemaker. Let’s explore each of these now.

AFib with symptomatic bradycardia

Pacemakers are used for people with AFib who have other heart rate issues. One example is if your heart beats too slowly and is causing symptoms.

This is called symptomatic bradycardia. It happens when your heart beats at a rate of under 60 beats per minute. It causes symptoms like:

Other heart rate issues

Another instance when a pacemaker may be recommended is if you have AFib and sinus node dysfunction. This is when the heart’s sinoatrial node doesn’t function properly. It can lead to:

  • tachycardia, which is a heart rate that’s too fast
  • pauses between heartbeats
  • a heart rate that alternates between too fast and too slow, called tachy-brady syndrome

Atrioventricular node ablation

Atrioventricular (AV) node ablation is a procedure that uses heat to destroy the tissue of the AV node. The AV node is located between the heart’s upper and lower chambers. It connects their electrical systems.

AV node ablation may sometimes be used to treat AFib. It prevents the irregular electrical signals associated with AFib from reaching the lower chambers of the heart, called the ventricles.

However, destroying the AV node tissue means your ventricles will no longer naturally receive electrical signals to pump. As such, a pacemaker is needed to provide these signals.

Is a pacemaker the last resort for people with atrial fibrillation?

Generally speaking, yes. A pacemaker is often used when more conservative treatments, like medications and lifestyle changes, haven’t effectively managed certain types of AFib.

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A cardiologist typically implants a pacemaker. This type of doctor specializes in heart conditions.

You may be able to go home after your pacemaker is implanted, or you may need to stay in the hospital for a night.

Traditional wired pacemakers are often placed transvenously. This is where your doctor threads the wires and electrodes of the pacemaker through your veins and to the chambers of your heart, placing the electrodes into your heart muscle.

Your doctor then places the pacemaker generator into an incision made in your chest. They connect the pacemaker wires to the generator. Before closing the incision, your doctor checks to make sure the pacemaker is working properly.

In some situations, a doctor can also place pacemaker electrodes directly onto the surface of the heart. This is called epicardial placement.

There are also wireless pacemakers in which the generator and electrodes are all in one device placed in the heart.

Risks from a pacemaker

There are several potential complications of having a pacemaker. These include:

  • infection
  • blood clots
  • scarring or stiffening of tissue around the pacemaker
  • a generator that moves out of place
  • pacemaker wires that move out of place
  • pacemaker malfunction
  • new-onset heart problems
  • pacemaker syndrome, which is when the pacemaker doesn’t work properly and causes new symptoms
  • collapsed lung

Certain electrical devices or those with strong magnetic fields can also interfere with your pacemaker. As such, you’ll need to take steps to avoid these devices or use them with caution.

A variety of other treatments may treat AFib. These include:


Medications for AFib aim to manage heart rhythm and rate and reduce the risk of blood clots that can lead to stroke and other complications. Medications include:

Lifestyle changes

Heart-healthy lifestyle changes can also help with AFib. Some examples include:

Procedures or surgeries

If medications and lifestyle changes aren’t effectively managing your AFib, your doctor may recommend a procedure or surgery, such as:

Some people with AFib may need a pacemaker placed, particularly people with a slow ventricular rate. A pacemaker can help prevent your heart rate from dropping below a set range.

Your doctor may also recommend getting a pacemaker if you have another heart rate issue in addition to AFib, such as an unusually fast heart rate, called tachycardia.

Additionally, if you’ve had AV node ablation as a part of your AFib treatment, you’ll need a pacemaker.

Implanting a pacemaker is generally safe. However, there are some risks to be aware of. Your doctor will inform you of these before placing your pacemaker.