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Nadim Al-Mubarak
Nadim Al-Mubarak, Doctor
Category: Cardiology
Satisfied Customers: 379
Experience:  MD at University Hospital Case Medical Center
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Is a pace maker for me? 1: right branch block 2: A-Fib

Customer Question

Is a pace maker for me?
1: right bundle branch block
2: A-Fib sufferer I have had 6 aversions
3: Recent angiogram showed that my four coronery arteries were clear
4: I have swelling in lower legs at days end
5: I regulary walk six kms which includes a very steep hill comfortably
6: I take Pradaxa and 200mg of Flecanide daily
Submitted: 1 year ago.
Category: Cardiology
Expert:  DrRussMd replied 1 year ago.


Thanks for the question.

I will be happy to help.

There is no indication for a pacemaker.

You don't have a 2nd or 3rd degree heart block.

Afib by itself is not an indication for a pace maker.

An option would be ablation of the a fib focus.

In some cases, the av node is ablated [when everything else doesn't work] and then a pacemaker is required.

OK, so you might have more questions or want to give me more information: Please use reply to expert if you have further questions. Also, please click a positive rating [hopefully excellent (5)—that’s how we are paid, per rating]. If you forgot something, just use reply and come back. I am here

Expert:  Nadim Al-Mubarak replied 1 year ago.


  • The treatment you are on now is a very good and viable treatment option. You seem to be tolerating the Pradaxa and Flecainide very well and you are not stating any symptoms that could indicate a failure of this treatment
  • Based on the information you provided, neither a pacemaker nor an ablation are treatments to be considered at this stage. Ablation (Not of a AFib focus as indicated by the prior expert) for Atrial Fibrillation is an extensive procedure that is most commonly considered for patients who are very asymptomatic and have failed the treatment you are on.
  • The RBBB is not of a clinical concern
  • Your mild leg swelling noted at the end of the day would have nothing to do with your AFib or the medications you are taking. It is most likely caused by mild inefficiency of your leg veins and can be treated by OTC compression stocking and other conservative measures. It is not serious

Best wishes