@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.