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

Posted by 1wife @1wife, 6 days ago

My husband, age 75, was diagnosed with afib February 2026. PCP, a NP, misdiagnosed and treated him for a cold from Nov 25 to Feb 26 instead of heart failure. He was able to leave the hospital after 9 days after 2nd attempt of a cardioversion. Many med adjustments. Ablation April 2026. EF and size of atria returned to normal 5 months post ablation. 25 mg 1x day of metoprolol cut in half and went into afib with fainting, pulse 180, 2 days later. Emergency room amiodarone infusion returned heart to sinus rhythm. Resting heart rate has been in the 40s since first afib episode. Now on 40 mg of sotalol 1x day. Electrophysiologist wants to put in pacemaker so that he can get the correct dosage of an arrhythmia medication. Now diagnosed with SSS. We are seeing another Electrophysiologist for a second opinion. Told to stay near a hospital in case this happens again. There seems like so many different approaches. What questions should we ask?

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Linda, Volunteer Mentor | @walkinggirl | 5 days ago
In reply to @1wife "@walkinggirl Thank you so much for taking the time to reply to my post. I will..." + (show)
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@walkinggirl

Thank you so much for taking the time to reply to my post. I will look at the link that you included. His second opinion is on Oct first and will be at NYU Langone Heart Rhythm Center in NYC.

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@1wife You are welcome! I am so, so, very glad he's going to NYU Langone Heart Rhythm Center in NYC, Langone is among the best places for heart care. You will be in superbly expert hands. Is NYC a far trip for you? I live in Upstate NY and travelled to Mayo in Rochester for surgery as recommended by my cardiologist.

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1wife | @1wife | 5 days ago

Hi Linda,

Thank you for your support. We live in Albany.

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1wife | @1wife | 5 days ago

Thank you so much for taking the time to write your comment. It seems like there are many many different variations of AFIB and treatments.

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1wife | @1wife | 5 days ago
In reply to @diane07710 "I was diagnosed with tachy-brady in fall of 2025. Got a pacemaker in June 2026 and..." + (show)
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I was diagnosed with tachy-brady in fall of 2025. Got a pacemaker in June 2026 and on the list for ablation. Happy so far with treatment at UW Madison WI.

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@diane07710

Thank you for your comments. You are lucky that you found a hospital that you are happy with.

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gloaming | @gloaming | 4 days ago
In reply to @bettycll "@1wife Putting in a pacemaker does not necessarily mean an AV Node Ablation. I had a..." + (show)
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@1wife
Putting in a pacemaker does not necessarily mean an AV Node Ablation. I had a pacemaker implanted for the reasons your EP indicated. An AAD lowered my heart rate to the point that I had a fainting episode. My pacemaker keeps the ventricles from beating too slowly. Knowing that your heart rate will not drop too low, another ablation or AAD can be tried. The pacemaker itself does not affect AFIB.

Years later, if nothing is successful stopping AFIB ( other AADs or ablations), certainly an AV Node Ablation can be done. I did have one 4 years after the pacemaker.

However - while a pacemaker is needed with an AV Node Ablation to keep the ventricles beating normally - an AV Node Ablation is NOT needed with a pacemaker. By the way, I am very happy that I have my pacemaker. Good luck!

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@bettycll This is true, and thanks for the information you provided. If a person's ventricles do not try to keep up during AF, then there isn't the problem many AF patients have that is called 'rapid ventricular response'. A patient with RVR, whose ventricular rate cannot be controlled normally, will almost certainly need to have their AV node destroyed when a pacemaker is installed. Additionally, if/when other more conventional treatments have failed to control AF, AV node is often the last resort.

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1wife | @1wife | 4 days ago
In reply to @gloaming "@bettycll This is true, and thanks for the information you provided. If a person's ventricles do..." + (show)
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@bettycll This is true, and thanks for the information you provided. If a person's ventricles do not try to keep up during AF, then there isn't the problem many AF patients have that is called 'rapid ventricular response'. A patient with RVR, whose ventricular rate cannot be controlled normally, will almost certainly need to have their AV node destroyed when a pacemaker is installed. Additionally, if/when other more conventional treatments have failed to control AF, AV node is often the last resort.

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@gloaming

Thank you for responding with this information. I appreciate the time that you are taking to write.

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Linda, Volunteer Mentor | @walkinggirl | 4 days ago
In reply to @1wife "Hi Linda, Thank you for your support. We live in Albany." + (show)
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Hi Linda,

Thank you for your support. We live in Albany.

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@1wife I live not far to the north of you just outside of Saratoga Springs and receive my heart care from the Albany Med group of cardiologists. St Peter's is also known for excellent heart care. I like the way my cardiologist, who used to be at a St Peter's affiliated practice, consulted with others when I was having an electrical problem after surgery. I wore a Holter for a month, many arrythmias were found. Was it difficult to schedule an appointment at Langone?

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1wife | @1wife | 4 days ago
In reply to @walkinggirl "@1wife I live not far to the north of you just outside of Saratoga Springs and..." + (show)
Profile picture for Linda, Volunteer Mentor @walkinggirl

@1wife I live not far to the north of you just outside of Saratoga Springs and receive my heart care from the Albany Med group of cardiologists. St Peter's is also known for excellent heart care. I like the way my cardiologist, who used to be at a St Peter's affiliated practice, consulted with others when I was having an electrical problem after surgery. I wore a Holter for a month, many arrythmias were found. Was it difficult to schedule an appointment at Langone?

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@walkinggirl

Hi Linda,

Langone has their appointments on the web site and we have an appointment for next week. I hope to let you know how it goes.

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