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 FAQs Understanding A-Fib: Pacemaker for Pauses?

FAQs Understanding Your A-Fib A-Fib.comMy cardiologist recommends a pacemaker to prevent blackouts during a pause as well as other serious heart problems.

I have paroxysmal A-Fib with “pauses” at the end of an event. I can’t tell how many of these I have experienced. Will they stop if my A-Fib is cured?

I am willing, but want to learn more about these pauses first.”

I had the same problem. I’d get pauses as long as 6 seconds and get dizzy, I felt like I was about to faint, etc. It was very frightening. But the pauses completely disappeared when my A-Fib was cured by a catheter ablation back in 1998.

Pauses are “Normal” in A-Fib

Pauses of up to 4 seconds duration in atrial fibrillation are considered as ‘normal’. Just because you have pauses doesn’t mean there is something wrong with your Sinus or AV Node and doesn’t mean that you need a pacemaker. When you are returned to normal sinus rhythm (NSR), these pauses usually disappear.

Unfortunately, many cardiologists don’t know this and will try to rush you into having a pacemaker implant.

Monitoring Your Symptoms

Are you symptomatic? Do you fall or faint from these pauses? (This is different from occasionally feeling lightheaded or dizzy.)

If your cardiologist hasn’t yet suggested it, you may need to wear a holter or similar monitor for a few days (or up to a month or longer).

Monitoring will tell your doctor exactly how long your pauses are and how often you have them.

Avoid Getting a Pacemaker, if You Can

I can understand your cardiologist’s concern, but try to avoid getting a pacemaker, if you can.

If you do have to get a pacemaker, make sure the cardiologist guarantees that it can and will be easily removed once you are restored to normal sinus rhythm (NSR). You don’t want to be saddled with a pacemaker for life when you don’t need it.

Depending on how a pacemaker is installed, it may make a catheter ablation more difficult. You may have to go to a more experienced EP for your ablation.

Be assertive. You may have to be very assertive about this. Most cardiologists will insist that you keep the pacemaker forever. (But it isn’t so.)

Cure Your A-Fib=No More Pauses

Ask your doctor about antiarrhythmic drugs. They generally don’t “cure” A-Fib but may reduce your pauses.

If your pauses cause you problems, consider a catheter ablation to cure your A-Fib.

Once you no longer have A-Fib, those pauses should stop and your heart should beat again in normal sinus rhythm.

To read a first-hand story about pacemakers, see Personal A-Fib Story #50: Pacemaker & A-Fib Ablation—You Can Have an A-Fib Ablation if You Have a Pacemaker

References for this article
Thanks to Mike Collins for this question.

Uebis, R et al. Asystolic pauses in atrial fibrillation. Incidence, dependence on the underlying disease and significance for pacemaker therapy. Dtsch Med Wochenschr, 1985 Jul 26;110(30): 1157-60.

Venkatesan, S. What is sinus pause? Expressions in cardiology, December 12, 2008.

Lo, HM et al. Implications of prolonged pause in patients with chronic atrial fibrillation with mitral valve disease undergoing atrial compartment operation. J Formos Med Assoc., 2003, Nov;102(11):762-7.

Go back to FAQ Understanding A-Fib

Last updated: Monday, June 18, 2018

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