The role of pacemakers in the management of patients with atrial fibrillation.

Pacemakers have an important role in the major strategies for the management of atrial fibrillation, rate control and rhythm control. Of all the current non-pharmacologic therapies for atrial fibrillation, the use of pacemakers impacts the largest number of patients. Pacemakers are used to facilitate medical management of atrial fibrillation with rate control agents and anti-arrhythmic drugs. Atrioventricular junction ablation in conjunction with pacemaker implantation can be an effective therapy for controlling a rapid ventricular rate during atrial fibrillation. The minimization of right ventricular apical pacing in patients with paroxysmal atrial fibrillation is an important objective. Cardiac resynchronization therapy devices are likely to be beneficial in select patients with chronic atrial fibrillation.