Tachy-Brady

Am healthy 52 yr female just diagnosed with Tachy-Brady/PAF/SSS.  No risk factors.  All tests (blood/xray/etc) good;  heart, valves, arteries healthy "just can't dance" (no rythm)  Set up for pacemaker but referred to an electro-physiologist who is hesitant to do due to my age, and otherwise healthy heart.  Wants to "wait and see" if I can "live with" symptoms and said I can continue regular activities.  If symptoms are not livable, will try medication first.  Suggested other treatments (for Tachycardia) before pacemaker.  Now do I need to get a 3rd opinion since, though the diagnosis is the same, treatment differs?  If so, would I see another electro-cardiologist?

[Michael J. McWilliams, M.D.]

My approach is the same as your latest electrophysiologist.  52 years old is very young for a pacemaker, although it is necessary sometimes.  I would give medications a chance before placing a device that cannot be taken out.  You dont have anything to lose by trying medications first.

If you start looking for second and third opinions, it will not take long to find someone that is willing to put in a pacemaker.  I have no way of knowing how significant your symptoms are, so you still have to really on  your doctors.

If you want a third opinion, I would use an electrophysiologist.

[Bromley]

This looks like a difficult question to field.  Some people can benefit from a pacemaker, and yet it is not just a simple matter to stick one in, and then take it out later if you dont like it.  For one thing, they dont always like removing the wiring after its in. Its not that easy and can be tricky.  At the same time, there are probably certain indications for a pacemaker, and you probably  want to make sure the indications are there because living with a pacemaker could come with drawbacks. The patient needs to understand the drawbacks, and weigh it against their situation, and not kid themselves (Sometimes a little time can help with this).  

How bad are your symptoms?  Would you characterize yourself as debilitated? Has the doctor determined that you would be safe or unsafe without one?  The doc probably needs this info to do your question justice.....

[Bromley]

Of course if you can get by without medicine of any type that would be even better!!

[bobad]

It all depends on the severity of the symptoms, and whether you can cope with them.  If the brady causes you to faint or get woozy-headed, and/or the tachy gets very high or of long duration, you may not be able to avoid the pacemaker. In fact, the pacemaker may be necessary to enable you to tolerate beta blockers, needed to slow down the tachy. I can tell you from experience to avoid the PM and the beta blockers as long as possible. They are about equally hard to live with,,, not horrible but certainly not trivial.  I can tell you they sure beat severe SSS, but not mild SSS. (if there is such a thing as mild SSS).

Good luck to you and your doctors in your upcoming decision.