From the Guidelines
Yes, a patient with a pacemaker can experience both atrial fibrillation and atrial flutter. Pacemakers are primarily designed to prevent the heart from beating too slowly and may not necessarily prevent or treat these rapid atrial arrhythmias. Standard pacemakers focus on maintaining adequate heart rates by preventing bradycardia (slow heart rate), but they don't typically suppress or prevent the abnormal electrical signals in the atria that cause AFib or flutter.
Key Points to Consider
- Some patients receive pacemakers specifically because treatments for atrial fibrillation (such as medications or ablation) might cause the heart to beat too slowly 1.
- If you have a pacemaker and develop symptoms like palpitations, shortness of breath, dizziness, or fatigue, you should contact your cardiologist promptly.
- Management options for AFib or flutter with a pacemaker might include medication adjustments, cardioversion, catheter ablation, or in some cases, upgrading to a more advanced device like a pacemaker with atrial therapies.
- Regular follow-up appointments for pacemaker checks are essential to monitor for these arrhythmias, as they can sometimes be detected during routine device interrogation before symptoms appear.
Important Considerations
- Atrial high-rate episodes have been observed in 10% to 28% of patients who have no prior history of AF, and these episodes are associated with a increased risk of stroke or systemic embolism 1.
- The ASSERT trial showed that patients with atrial high-rate episodes had a >5-fold increase in subsequent diagnosis of atrial arrhythmia on ECG and a 1.60% per year rate of stroke or systemic embolism compared with a 0.69% per year rate for those without high-rate episodes during the first 3 months 1.
Recommendations
- Patients with pacemakers should be closely monitored for atrial fibrillation and atrial flutter, and management options should be tailored to the individual patient's needs.
- Regular follow-up appointments and device checks are crucial to detect and manage these arrhythmias early, reducing the risk of stroke and other complications.
From the Research
Atrial Fibrillation and Atrial Flutter in Pacemaker Patients
- A patient with a pacemaker can experience both atrial fibrillation and atrial flutter, as evidenced by studies that have investigated the incidence of these arrhythmias in pacemaker recipients 2, 3, 4, 5, 6.
- The incidence of atrial fibrillation and atrial flutter in patients with implanted pacemakers has been reported to be significant, with some studies suggesting that the recurrence of atrial fibrillation is not prevented by physiological pacing 4.
- Asymptomatic atrial fibrillation is common in pacemaker recipients, and prior history of atrial tachyarrhythmias is associated with higher arrhythmia burden 5.
- The incidence of atrial fibrillation or flutter in patients with dual-chamber or atrial pacing is moderately low, but it is not possible to identify patients with a high risk for development of atrial fibrillation 6.
- Pacemaker therapy can be used to manage patients with atrial fibrillation, and newer applications of pacing, such as biatrial pacing and multisite atrial pacing, are being investigated for the prevention of atrial arrhythmias 3.