Coping with A-Fib: Pacemaker for Too Slow a Heart?Atrial Fibrillation: Resources for Patients

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FAQs Coping with A-Fib: Pacemaker

“Now my doctor says I need a pacemaker, because my heart rate is too slow and because I’m developing pauses.

I’m an athlete with A-Fib and have a naturally slow heart rate. Since I developed A-Fib, I was put on atenolol (a beta blocker) which really slows down my heart rate. What should I do?”

Get a second opinion. It’s crazy to go through the risks and lifestyle disruptions of having a pacemaker implanted just to be able to continue taking atenolol.

Because you are an athlete, your heart rate is naturally slow. But it’s normal for you.

As long as you feel fine and aren’t fainting from lack of blood flow, don’t be talked into getting a pacemaker. A slow or even very slow heart rate usually doesn’t cause any harm. As for heart rates, “normal” is indeed a wide swath.

In the words of Dr. John Mandrola:

“Do not implant pacemakers in patients with nonsymptomatic bradycardia (slow heart rate).The same holds for pauses, though they are certainly of more concern than a slow heart rate. Nonsymptomatic slow heart rate or pauses don’t justify exposing patients to the risks of implanting a pacemaker.”

But be advised that pacemakers tend to have bad effects over the long term, “…long-term morbidity (is) associated with a pacemaker.”

Another consideration is that implanting pacemaker ‘leads’ in the veins of the upper chest often prevents or hinders future procedures that require vascular access like a PVI. A pacemaker usually isn’t implanted unless your heart rate is too slow or you have Sinus Node and/or Atrioventricular (AV) Node problems.

Resources for this article

¤ Mandrola, John “Choosing wisely: The electrophysiology list of five don’ts.” http://blogs.theheart.org/trials-and-fibrillations-with-dr-john-mandrola/2012/4/9/choosing-wisely. ¤ Atrial Fibrillation Educational Material” University of Pennsylvania. 2002, p. 3. ¤ “Should atrial fibrillation ablation be considered first-line therapy for some patients?” Circulation 2005;112:1214-1231, p. 1228.

Back to FAQs: Coping with Your A-Fib
Last updated: Tuesday, August 20, 2019

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