Can a pacemaker remove or reduce palpitations?

From the Guidelines

A pacemaker can reduce or eliminate palpitations in certain situations, particularly when they are caused by an abnormally slow heart rhythm (bradycardia) or pauses in the heart's electrical activity. Pacemakers work by delivering small electrical impulses to maintain a regular heartbeat when the heart's natural pacemaker isn't functioning properly. However, pacemakers are not effective for all types of palpitations, especially those caused by rapid heart rhythms (tachycardia), premature beats, or non-cardiac causes like anxiety or stimulants.

The decision to implant a pacemaker is based on the specific cause of palpitations, which is determined through diagnostic tests like ECGs, Holter monitors, or electrophysiology studies 1. According to the 2012 ACCF/AHA/HRS focused update incorporated into the ACCF/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities, an implanted pacemaker may be useful to treat or prevent recurrent ventricular and supraventricular tachycardias (SVTs) under certain circumstances 1.

Pacemaker implantation is a minimally invasive procedure typically performed under local anesthesia, with most patients returning home within 24 hours. After implantation, patients need regular follow-up appointments to check the device's function and battery life. It's essential to understand that while pacemakers can effectively treat certain rhythm disorders, lifestyle modifications and medications are often tried first for managing palpitations. The efficacy of atrial ATP is difficult to measure, but approximately 30% to 60% of atrial tachyarrhythmias may be terminated with atrial ATP in patients who receive pacemakers for symptomatic bradycardia 1.

In general, correlation of symptoms with bradycardia is determined by ambulatory ECG or an implantable loop recorder, and symptomatic bradycardia is an indication for pacemaker implantation provided that other causes have been excluded 1. Alternative causes to be considered include apnea, seizures, medication effects, and neurocardiogenic mechanisms. In carefully selected cases, cardiac pacing has been effective in the prevention of recurrent seizures and syncope in infants with recurrent pallid breath-holding spells associated with profound bradycardia or asystole.

Some key points to consider when evaluating the effectiveness of a pacemaker in reducing palpitations include:

• The type of heart rhythm abnormality causing the palpitations
• The presence of underlying heart disease or other medical conditions
• The patient's overall health and medical history
• The potential risks and benefits of pacemaker implantation
• The availability of alternative treatments, such as lifestyle modifications or medications.

Overall, while a pacemaker can be an effective treatment for certain types of palpitations, it is essential to carefully evaluate each patient's individual situation and consider all available treatment options before making a decision.

From the Research

Pacemaker Functionality

• A pacemaker is a medical device that uses electrical impulses to regulate the beating of the heart 2.
• The primary purpose of a pacemaker is to maintain an adequate heart rate, either because the heart's natural pacemaker is not fast enough, or there is a block in the heart's electrical conduction system 2.
• Pacemakers can be temporary or permanent, and are used to treat short-term or long-term heart rhythm problems, including bradyarrhythmia, which is characterized by an abnormally slow heart rate 2, 3.

Effectiveness in Reducing Palpitations

• Palpitations are a common symptom of bradycardia, and can be relieved by the implantation of a permanent pacemaker 4.
• A study found that dual-chamber pacemakers were associated with a reduction in palpitations and other symptoms, compared to single-chamber atrial pacemakers, in patients with sick sinus syndrome without atrioventricular block 4.
• Another study found that atrioventricular nodal ablation, which is often performed in conjunction with pacemaker implantation, can reduce the need for antiarrhythmic drugs and improve symptoms, including palpitations, in patients with bradycardia-tachycardia syndrome 5.

Mechanism of Action

• Pacemakers work by sending intermittent electric impulses to the heart muscle, stimulating it to contract and ensuring a steady heart rate 3.
• This can help to regulate the heart's rhythm and reduce symptoms such as palpitations, fatigue, and fainting 2, 3.
• Modern pacemakers are externally programmable, allowing cardiologists to select the optimum pacing modes for individual patients 2.