What is done for Bradycardia and Tachycardia syndrome- if pacemaker -

I had a dual chamber pacemaker inserted 2 months ago, to assist with brady/tachy syndrome. Was collapsing and blacking out due to very low b/p. I still get a lot of a-fib and atrial flutter but it is not as noticeable as prior to pacemaker implant.
Like yourself, I do not wish to have an ablation. As a consequence I have been prescribed diltiazem now in addition to the only other medication I was taking - bisoprolol. Neither are strong doses as my system is SUPER sensitive to all medications.
So far, so good apart from one side effect, being muscle aches and pains. I’m monitoring it and may reassess.
Hope this helps you.

I had a pacemaker implanted a number of years ago, for sick sinus syndrome, which in my case involved both tachycardia and bradycardia. The pacemaker is in these cases implanted to prevent the heart rate from going too low, it does not prevent tachycardia from occurring.

When a person with tachy-brady is treated with rate control drugs (such as a beta blocker, such as the metoprolol I take, or the bisoprolol you take as well as diltiazem) to lower the heart rate, these drugs can lower the heart rate to where it's too low. IN those cases, when medical treatment of tachycardia is preferable, a pacemaker may be implanted to keep the heart rate from going too low, and it may allow for increased dosages of those drugs when they're needed without the drugs driving the heart rate even lower.

This approach has worked well for me over the years. I've never had an ablation, and my tachycardia ( A-fib and atrial tachycardia) has been for the most part well controlled with the beta blockers I take. And the pacemaker was a game changer for me.

After dealing with symptoms, many ER visits and hospitalizations, differing diagnoses
for several years I had a loop recorder implanted in 2019. It helped to diagnose the real problems of Long QT, Bradycardia, Sick sinus, afib, etc. Meds didnt really help and I had a serious afib event in 2021 and had a cardioversion and a Boston deal chamber pacemaker implanted after removing the loop recorder. I was 59. I continued to have afib events that would land meback in the hospital and meds would usually work to get me back into an I rm rhythm.
In 2022, I went into yet another bad afib event, meds and cardioversion did not get me out of afib so I had an emergency ablation. It was a complicated one, with around 200 ablation points. Thats not a typo, two hundred.
My EP said I was in afib much longer than he thought, hence the complications. I still take atenolol, spirolactone and Eliquis, but just went to the hospital this week for another extended afib event and I somehow converted back to a normal rhythm on my own.
So long story short, get second or third opinions on type of PMs. Same with ablations. For me, I know I would not be here if I had not had a dual chamber pm and ablation. Still dealing with rhythm issues at age 62 but doing everything I can to stick around as long as I can