Dysautonomia with Tachy-Brady Syndrome, pacemaker indicated?

I am a 26 year old male, diagnosed with dysautonomia. I have been having major health issues ever since I was 9 years old. I was wondering if Tachy-Brady Syndrome can coexist with Postural Tachycardia Syndrome and what the best treatment options are. Is a pacemaker indicated? Since my cardiologist mentioned it as a last resort.

Tests that have been done and results:

- Tilt table test: cardio-inhibitory response after 15min. Diagnosis: neurocardiogenic syncope

- ECG and holter-monitoring: manifest sinusbradycardia most of the time (45 bpm), nocturnal AV-dissociation and severe bradycardia (30 bpm)

- Stand test: occasional tachycardia upon standing (sometimes heart rate going as high as 180, once measured 200 bpm, this means my resting heart rate sometimes quadripples upon standing ), diagnosis: Postural orthostatic Tachycardia Syndrome

- Stand test: occasional hypotension

very labile blood pressure in general

- Electrophysiological testing: no inducable arrhytmias

- MRI: atypical white matter brain lesions (apparantly not disturbing, probably due to migraines), nasopharyngeal cyste (not disturbing either)

- Blood tests: minor renal insufficiency

Family history: vascular disorders, auto-immune (Graves), renal disease, autonomic dysfunction symptoms in a few members of one side of the family (mother, grandmother, uncles) but no diagnosis.

Hope someone can answer my question.
Thank u in advance!

[itdood]

Someone posted on here last week about trying a procedure where they did something to the nerves heading to the heart.  I don't know if they were cut or temporarily disable in some way.  This modified the signals in some to the heart from the central nervous system.  As you sound aware, CNS is what's affected in dysautonomia.

This person was suffering from tachycardia.  She was days away from ablating her sinus node which would mean permanent dependence on a pacemaker.  Her doctor decided to give this procedure a try and she reported good result so far.

This isn't exactly what you are suffering from, but the treatment options sound very similar.

here's the post

http://www.medhelp.org/posts/Heart-Rhythm/Anyone-had-a-nerve-block-for-Tachycardia/show/1686184#post_7838062

[is_something_wrong]

Yes, they can, but first, let me ask, are you diagnosed with tachy/brady-syndrome, or do you assume that from the major increase in heart rate when standing up, etc?

Orthostatic tachycardia/hypotension is usually caused by an autonomic dysfunction/dysregulation, as you mentioned. Tachy/brady-syndrome is also known as sinus node dysfunction or "sick sinus" syndrome, and may have two causes; 1) dysfunctions in autonomic input on the sinus node, or 2) diseases in the sinus node itself. The last one is most common with higher age.

If you have high-degree AV dissociation at night (third degree AV block) I thought a pacemaker was necessary. I can't really see the downside of having a pacemaker if it's necessary, as you will get a guaranteed minimum heart rate of say 50-60 bpm, so the tachycardia will be safe to treat with beta blockers, and so, that is gone too. That will probably also take care of your labile blood pressure?

Short answer: Yes, they can coexist. No, they don't necessarily have to. Ask your cardiologist what the best treatment option is.