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

@marybird - Just joined, months after your post, so hoping you see this.

You said "the pacemaker was a game changer for me." I'm ambivalent and scared, but that's probably what's going to happen soon, so could you please explain what, why, how it turned out to be a good thing for you?

I had bradycaradia. I had q pacemaker put in and it immediately helped me with shortness of breath. It was a simple procedure with a short recovery time.

@earther Mary may not return here to reply early enough for your needs, so I hope both of you won't mind my (interim and substituted) reply.

A pacemaker is usually the last resort for a troubled heart that is working poorly........electrically. Even if a heart is in what is horribly termed 'heart failure', a pacemaker can correct a faulty rhythm and bring the heart almost back to it's normal state.....just because it fixes the rhythm. Remember that rhythm in a heart is not just lub-dub. It's actually several structures reacting to several nerve and sequencing signals originating from the sino-atrial node. With four separate chambers acting as pumps, it's not a simple function or process. Naturally, some people feel awful when they have the arrythmia, while some are quite asymptomatic; they have no sensation that anything is wrong, so they feel well, if a bit out of breath of feeling a bit unsteady on their feet for some strange new reason they don't understand.

The pacemaker can correct these faults and restore normal heart function, and with normal rhythm and function comes a rejuvenated heart in many cases. If there was any hypertrophy, it might reverse. It does in some people, not in all. This is an example of what can improve with a pacemaker, not mention that all those nasty symptoms might disappear in a few weeks. This means improved sleep, improved vision, improved cognitive processes, improved mood...you get the idea. So, a pacemaker offers a lot of promise to an ailing heart. Try to look at it that way. As far as I know, and no I don't have one, the implantation takes just a short while, not even real 'day surgery'. It's just a short procedure and you go home inside of a couple of hours.

@earther Well, there are lots of factors that figure in to an individual's responses to getting a pacemaker, and I'd probably have to admit that most of "my" factors as it were, favored a good outcome with a pacemaker. I was in my early 70's when I got my pacemaker, and had had a long history of tachycardia- SVT, for which I was treated with increasing doses of metoprolol over the years. For the most part this drug worked well to control my heart rate, though it took increasing doses to control the tachycardia, and I think I had normal heart rate most of the time. But after a number of years I began having episodes of bradycardia- with heart rates dropping into the low 40's and even high 30's at times. At first this was short-lived and my heart rates would go back up appropriately with activity. My cardiologist didn't worry about the bradycardia at that point. But over a couple of years, the bradycardia got more frequent, even while I also got tachycardic episodes as well. My heart rates would go into high 30's-low 40's whenever I stopped any activity, and it got to the point where the highest it would go was into the low 50's even with vigorous activity- and any time I stopped for a minute it would go back into the 40's. That was interspersed with tachycardia at which time my heart rate could go into the 170's, then back down to 40. This went on, sometimes better, more often as time went on worse and I was feeling tired, light-headed and short of breath, sometimes barely able to function as this happened. I guess this went on for a bit over 2 years, till after a cardiac cath showed "the coronary arteries of a teenager" according to my cardiologist, I was referred to a cardiac electrophysiologist. I thought perhaps he would do an ablation for my tachycardia and that might fix the bradycardia if I could stop the metoprolol after that.
The EP looked at all my records ( I'd had monitor testing several times before that which showed both the tachy and the brady), informed me he thought the tachycardia was atrial tachycardia, hard to induce in the EP cathlab so hard to ablate, and sick sinus syndrome ( sinus node dysfunction. We had had a thought that perhaps the metoprolol was causing the bradycardia, even though my bradycardia times didn't follow a pattern one would see if it were drug related. He suggested I gradually taper off and stop the metoprolol, and begin taking another heart rate med, ie, diltiazem, to see if that would help control the tachycardia, and keep my heart rate more at normal level. If this failed he would put in a pacemaker.

I took the diltiazem alone for about 6 weeks, but it was a trial, I still had the bradycardia, and it didn't do much to control the tachycardia, so I felt miserable. After that the EP put in the pacemaker. I felt better afterwords, somewhat, though I was going through some of the expected post-surgery discomfort ( not too bad for me, really). But it wasn't till they turned on the "rate response" control on my pacemaker at the post-op 5 week visit that I noticed a humongous difference in the way I felt. The rate response allows the pacemaker to increase pacing to match the person's activity level, and I've found it a gamechanger. The EP set my lower pacing rate to 55, explaining that I didn't need to pace up to 60 when I was sleeping, but that it would be higher with any activity at all, and that's the way it has been.

I don't check my heart rate that often these days, figuring that it's where it's supposed to be and I don't worry about it. I check occasionally with a pulse oximeter we have, I've done it sometimes just for the joy of seeing my heart rate at 75 when I'm up and busy.

The difference in my heart rate and my being able to carry out daily activities and feeling just fine doing so, compared to before I got the pacemaker is where the gamechanger lies. I'd cook meals, clean, attempt yardwork, wash windows, go for walks and my heart rate wouldn't go above 53. I'd be frustrated as I thought a 53 HR should be just fine and why should I be exhausted to the point where I had to stop at that heart rate? I had a couple of "near-syncope" episodes trying to get stuff done- mostly when I would stop and take a breath and my HR would fall to 41. After the pacemaker, my heart rate goes into the mid-high 70's or 80's with these activities, and I feel just fine doing them. Sometimes you don't know how bad you really felt till you feel better.

I was also reluctant to get a pacemaker, wondering if even with all these issues I needed one. It's such a permanent thing, you wonder how you're going to make out with that little titanium device implanted in your chest with its leads going into your heart ( unless you get one of those leadless pacemakers, but that's another whole topic. My atrial pacing rate has been around 90% since I got the pacemaker 6 years ago, and now with a small amount of heart block my ventricular pacing is around 20%, so I guess they were right about the SSS progressing. I don't feel the pacemaker anymore, and see only a slight "bump" where it's located. Life's normal, and days pass where I don't even think of the pacemaker. But it's there doing its job.

Best of luck to you.

My 1st pacemaker with 2 wires installed age 68 or 69. Bradycardia around 35 bpm and then Tachycardia at 170 bpm.
Atenolol prescription for Tachycardia. Eventually Afib 100%.
Since the beginning pacemaker, I am now 94 and on my 4th pacemaker when battery life expired. I pace 86% of the time. I now have and probably did have early heart failure and each valve has aged and the aorta artery is narrowing. So for me the pacemaker for bradycardia has been a blessing.
Warfin a daily ritual along with direutics vital.
I have a number of other issues along with vein disease, severe osteoporosis. Hyper parathyroid and Hypo Parathyroid.
It seems to me like they all go together. They tell me I have a 12 year life in my new pacemaker. I am 94.

My pacemakers have always been set at 70 beats per minute as I maintained a heavy business schedule and worked till 77 years of age

@marybird
I too have bradycardia, It has been getting worse with age. I am a 77-year-old male, I am going to have a pacemaker procedure done in early December. Your article is very much appreciated!!
It is conforming to know it might help me as well,

Jim Gill