Do I need a pacemaker

[cc1968]

Two years ago I was diagnosed with Dysautonomia after wearing an event monitor for five weeks.  Episodes of sinus arrhythmia occured and my low heart rate was 46 and high was 147.  In April I started feeling very tired.  I'm a teacher and during a lecture I would feel like I could fall asleep.  I would check my h/r and would be at 44.  Most often my h/r is in the 50's but it's not unusual to be in the 40's, which makes me nervous.  I feel best and full of energy when it's in the 60's.  I went back to the cardiologist and he sent me for a tilt table to test to confirm whether or not I have dysautonomia.  My starting heart rate was 55 and B/P 119/64.  18 minutes into the test I passed out, my h/r was 38 and b/p 64/28.  I was told the two top chambers stopped working so the bottom kicked in and started working harder.  I do have family history of sudden death.  Maternal grandmother and grandfather, maternal aunt and uncle.  My mother also has an arrhythmia but no symptoms.  For two years I've been told I look great, I exercise, I'm healthy - which I am, but something is not right.  Finally with this test, it shows that yes, something is not right.  Does a pacemaker seem like the best treatment?  If given a choice that's what I would choose, I'd like to be fixed and not treat with medication.  I'm 41 and don't want to spend the rest of my life on medication.  I've been a wreck since the tilt test in July and my appointment is Monday 8/17 with Electro-Cardiologist.  

[Lee Kirksey, MD]

Hello
It clearly sounds like your dysrhythmia is affecting how you feel. As you know, the diagnosis and management of arrhythmias require taking into account your exam, test findings and factors like your level of activity and personal wishes. Having said that, I would hesitate to tell you that medical therapy should be bypassed in lieu of a procedure, ie pacemaker. Although a pacer does seem like a valid option, recognizing that a pacer carries risks, including infection, vessel thromboses, pacer wire fracture. Have a detailed conversation with your cardiologist after he reviews your test results. Keep an open mind and trust that staged therapy is often the best option. Best of health

[cc1968]

Also, forgot to mention during Tilt table test, P-waves were hidden.  Not sure what that means.