Should I get a pacemaker diagnosed w/afib, tachy-brady and now SSS?

Sorry this has happened. It must be very distressing to you both.

The pacemaker usually means they will ablate the AV node, the node that passes the SA node's electrical signals on to the two large vessels below the atria, they being the ventricles. When I say ablate, I mean 'nuke' it. They permanently destroy the AV node because it wants to make the ventricles' rate of beating match what the chaotic beat is above them, in the left atrium (which is the fibrillation). This rapid rate is harmful if it persists and lasts for long periods of a few days or more, which is likely where this is all headed. It's a muscle after all, and it will tire and degrade...which nobody wants.

A first attempt at ablation has failed. Has anyone suggested what was missed the first time, or if this is a new and inevitable progression, his new acute circumstance with the hospitalization? I would think that a new set of eyes, in the skull of a 'nuther EP, might see you facing one or more new options that at least 'sound' better than what the current EP is suggesting...the pacemaker. For example, unless there's something about your husband that neither of us knows about and/or understands that make a second ablation unworkable, maybe even dangerous, it's not unusual for a first ablation to fail. Been there myself. Second attempt has me in steady and reliable NSR for 38 months now. I would want to know why a second ablation is not in the works, and that would be my first question to an EP. It may be clear-cut when you hear the answer, and at least that option can be ruled out, even in your eyes.

Pacemakers are meant to regulate the ventricles....they don't always correct an arrhythmia like AF. In fact, in order to save some patients' lives, they implant a pacemaker and tell the patient he/she'll have to live with AF permanently and to make the best of it. If the patient is highly symptomatic when in AF, and suffers unduly....................................................do I need to spell it all out?

There are a couple of 'final solutions' in cardiology. The first is the AAD amiodarone, the anti-arrhythmic drug. It's the drug of last resort because it carries a lot of risk to the patient with toxicity. The second is the pacemaker. Once they feel there's nothing else they can do but to destroy the AV node and put the patient on a pacemaker, that's it for life. There's no going back. But I wouldn't submit to either of those unless there were really, and convincingly, no other options, especially none a conscientious and scrupulous physician were willing to try. I would wonder about at least trialing an AAD like flecainide, maybe Dofetilide...if the EP thinks it's worth a shot, propafenone...? Or, a second attempt at an ablation. There are EPs out there who specialize in 'complex' cases, of which your husband's may be one example. Maybe all he needs is his left atrial appendage isolated (LAA). Maybe the coronary sinus, or the Vein of Marshall. Why isn't this EP amenable to investigating those, or has he already and ruled them out for certain? Does he have the skills and experience to perform those types of ablation if they are indicated? There's two more questions.

Sorry this has happened. It must be very distressing to you both.

The pacemaker usually means they will ablate the AV node, the node that passes the SA node's electrical signals on to the two large vessels below the atria, they being the ventricles. When I say ablate, I mean 'nuke' it. They permanently destroy the AV node because it wants to make the ventricles' rate of beating match what the chaotic beat is above them, in the left atrium (which is the fibrillation). This rapid rate is harmful if it persists and lasts for long periods of a few days or more, which is likely where this is all headed. It's a muscle after all, and it will tire and degrade...which nobody wants.

A first attempt at ablation has failed. Has anyone suggested what was missed the first time, or if this is a new and inevitable progression, his new acute circumstance with the hospitalization? I would think that a new set of eyes, in the skull of a 'nuther EP, might see you facing one or more new options that at least 'sound' better than what the current EP is suggesting...the pacemaker. For example, unless there's something about your husband that neither of us knows about and/or understands that make a second ablation unworkable, maybe even dangerous, it's not unusual for a first ablation to fail. Been there myself. Second attempt has me in steady and reliable NSR for 38 months now. I would want to know why a second ablation is not in the works, and that would be my first question to an EP. It may be clear-cut when you hear the answer, and at least that option can be ruled out, even in your eyes.

Pacemakers are meant to regulate the ventricles....they don't always correct an arrhythmia like AF. In fact, in order to save some patients' lives, they implant a pacemaker and tell the patient he/she'll have to live with AF permanently and to make the best of it. If the patient is highly symptomatic when in AF, and suffers unduly....................................................do I need to spell it all out?

There are a couple of 'final solutions' in cardiology. The first is the AAD amiodarone, the anti-arrhythmic drug. It's the drug of last resort because it carries a lot of risk to the patient with toxicity. The second is the pacemaker. Once they feel there's nothing else they can do but to destroy the AV node and put the patient on a pacemaker, that's it for life. There's no going back. But I wouldn't submit to either of those unless there were really, and convincingly, no other options, especially none a conscientious and scrupulous physician were willing to try. I would wonder about at least trialing an AAD like flecainide, maybe Dofetilide...if the EP thinks it's worth a shot, propafenone...? Or, a second attempt at an ablation. There are EPs out there who specialize in 'complex' cases, of which your husband's may be one example. Maybe all he needs is his left atrial appendage isolated (LAA). Maybe the coronary sinus, or the Vein of Marshall. Why isn't this EP amenable to investigating those, or has he already and ruled them out for certain? Does he have the skills and experience to perform those types of ablation if they are indicated? There's two more questions.

@gloaming

They want to put in the pacemaker because the AADs lower your heart rate. The doctor said if they put in a pacemaker, they could try a normal dose of an AAD and maybe another ablation. He has no coronary artery disease.

@gloaming

They want to put in the pacemaker because the AADs lower your heart rate. The doctor said if they put in a pacemaker, they could try a normal dose of an AAD and maybe another ablation. He has no coronary artery disease.

@1wife The idea of AADs is to restore normal rhythm, and it usually means a reduction in heart rate at the same time if it's one of the tachyarrhythmias. But that reduction in rate is an artefact of the regulation and restoration of rhythm, not the goal per se. Is it his experience that AADs reduce his HR into bradycardia territory, say less than 50 BPM, that makes him light-headed and windy?

@1wife Welcome to Mayo Clinic Connect, a forum where you can meet others with similar health issues. It is not a place to get professional medical care. We share our experiences and information. Please identify acronyms (SSS is sick sinus syndrome, I had to look it up), many of us are unfamiliar with the endless number of acronyms in cardiology (and in life). Between those acronyms and all those alike-sounding medications and procedures, doctors need the most excellent ability to remember all of it!

While others responding to your post have made suggestions, medical questions should be directed to your professional care givers.

I have an ICD to regulate an electrical problem that resulted in arrythmias after a septal myectomy, it solved the problem and I am grateful!

You are looking for good questions to ask when you accompany your husband to his next appointment. Here is a link that you both can read and discuss, I am hoping it will help you generate questions along with those stemming from the other comments on your post. https://www.mayoclinic.org/diseases-conditions/sick-sinus-syndrome/symptoms-causes/syc-20377554.

Your husband is probably looking forward to hiking and biking again! We have trouble remembering that this is the Art of Medicine, our individual differences prevent it from being an exact science. Is he aligned with a facility that is known for excellent heart care? When is your second opinion appointment?

@gloaming

They want to put in the pacemaker because the AADs lower your heart rate. The doctor said if they put in a pacemaker, they could try a normal dose of an AAD and maybe another ablation. He has no coronary artery disease.