What is the role of a pacemaker in managing arrhythmia?

Question

Hello doctor,

I am a 63-year-old male with a history of atrial fibrillation (AF) for the past 20 years. I had a brain hemorrhage 23 years ago and have a paroxysmal type of AF. Recently, the frequency of my AF episodes has markedly increased. I am currently taking Sotalol 80 mg twice daily. However, an increase in Sotalol now leads to bradycardia when my rhythm is in the sinus. My cardiologist recommends implanting a pacemaker to manage the bradycardia. Could you please explain the role of a pacemaker in arrhythmia? My cardiologist mentioned that the pacemaker remains inactive during abnormal rhythms.

Please suggest.

Answer 1

Hello,

Welcome to icliniq.com.

The heart rate in atrial fibrillation (AF) is controlled with beta-blockers, calcium channel blockers, or Digoxin. You are taking Sotalol, which acts as both a beta-blocker and an anti-arrhythmic drug. A permanent pacemaker is typically implanted in cases of tachy-brady syndrome, where episodes of tachycardia (fast heart rate) alternate with episodes of bradycardia (slow heart rate). When we control the tachycardia, the bradycardia episodes may become more pronounced, and vice versa. In such cases, a pacemaker is implanted to prevent severe bradycardia, while medication is used to manage the tachycardia. The pacemaker is programmed to pace the heart when the rate falls below a certain threshold, such as 60 bpm.

Paroxysmal AF is a type of AF where the rhythm spontaneously returns to normal within seven days. Persistent AF lasts from seven days to 12 months, while long-standing persistent AF persists for more than 12 months. Cryoablation is a technique used to restore normal sinus rhythm, primarily in cases of paroxysmal AF, although there are some trials for its use in persistent and long-standing persistent AF with successful ablation outcomes. Please consult your cardiac electrophysiologist to discuss the possibility of this procedure for your case.

I hope this helps you.

Thank you.