How are pacemakers used to treat 'slow' atrial fibrillation (AF)? In this video from our Pacemaker Essentials course, we'll take a look at why we use pacemakers for atrial fibrillation, what type of pacemaker is best to use, and what type of pacemaker is considered useless.
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[00:00:00] In this lesson, we will look at how pacemakers are often used to treat atrial fibrillation. Atrial fibrillation describes a condition where the normal contraction and electrical activity of the atria has been replaced by disorganized, chaotic electrical activity. The AV node is bombarded by this chaotic activity and it's not always certain on how to respond. This leads to a
[00:00:30] heart rate that is always irregular, sometimes slow, sometimes fast, and quite often played with pauses. When we talk about pacing, we're interested in slow atrial fibrillation, so atrial fibrillation that results in insignificant pauses between heartbeats. Let's have a look at what pacemakers we have on offer to treat this patient’s symptoms. Single-chamber pacemaker with an atrial lead, well,
[00:01:00] this is because any electrical signal sent down the pacing lead to try and stimulate a contraction will just be met by that chaotic electrical activity. It is impossible to pace the atria during atrial fibrillation. So, even though the AV node might be healthy, we cannot get a good signal into the atria. So, in permanent atrial fibrillation, the pacemaker of choice is a
[00:01:30] single-chamber pacemaker with a ventricular lead. Let's have a look at how this might work. Here we have QRS complexes reasonably close together and the pacemaker can see that the heart is beating. Now, all of a sudden, a significant pause starts to recur. The pacemaker recognizes this, delivers an output post into the ventricles and creates this broader
[00:02:00] pacing complex. This will alleviate any symptoms the patient is having as a result of significantly slow heart rate or significant pauses. We don't need an atrial lead because we know this person's in atrial fibrillation and all this information is garbage, it's of no use to us. So, that's why in permanent atrial fibrillation, we don't need an atrial lead. It is worth noting that in paroxysmal atrial fibrillation,
[00:02:30] it's the intermittent AF, a dual-chamber pacemaker is a good pacemaker of choice. This is for two reasons. Firstly, the atrial lead is able to receive signals from the atria, so it can tell the pacemaker when the atria have started to fibrillate, when AF is occurring. And at the same time, during sinus rhythm, the atrial lead is able to use that information from the atria
[00:03:00] and if necessary, create good correlation between atrial contractions and ventricular contractions. So, your takeaway message, in chronic atrial fibrillation, a single-chamber ventricular pacemaker is the weapon of choice. Information from the atria is worthless.