Pacemaker Therapy in Atrial Fibrillation

There are a number of different roles for pacemaker therapy in the management of Atrial Fibrillation (AF). The most common indication for pacing in AF is to prevent bradycardia in patients with rapid ventricular rates and sinus node dysfunction. Atrioventricular (AV) junction ablation can be an effective alternative therapy for elderly patients or patients with significant medical comorbidities who have highly symptomatic, drug-refractory AF. Ventricular rate regularization is another pacemaker strategy that can decrease the symptoms of AF by pacing near the mean intrinsic ventricular rate during AF. Other pacing algorithms attempt to decrease the incidence of AF by promoting or maintaining sinus rhythm, but the magnitude of this overall effect is modest. Finally, pacemakers can also serve as a diagnostic tool for monitoring frequency of AF and providing information on AF burden, including asymptomatic episodes.