@nadanoel You can cut back on metoprolol if a formal assessment says you can.....one given by a physician/cardiologist. The metoprolol keeps your heart rate down WHEN you are fibrillating, which might not be all the time. If you know for a fact that you are in the 'long-standing persistent' stage or the 'permanent' stage, then stopping metoprolol is almost certain to be a bad idea....even cutting down on it. Your heart can't beat indefinitely at rates higher than 100 BPM, and metoprolol is meant to stunt it's inclination to rise above that figure. If you are on metoprolol and still having a higher rate than 100 BPM, see a cardiologist right away....yesterday would have been great...or go to your local emergency department.

Pacemakers can't always control for AF. Sometimes they can, often they can't. What the most recent versions do is to control the heart's ventricles to keep them at pace, but it might still mean the atrium is beating chaotically. Sometimes, the physicians tell you that you must have your AV node, the lower of the two in the heart, destroyed, usually by catheter ablation. When it is destroyed, it can't send loop-back signals into the left atrium and the left ventricle, at which your new pacemaker would have to be the sole generator of signal to keep your heart beating. It's permanent, final, and only your pacemaker would keep your heart going.

Note that none of this is my advice or suggestion...I am not a qualified medical practitioner, just an interested patient with AF himself. Controlled via the second of two ablations.