arrhythmia after pacemaker

[dl]

3 months ago I had a dual chamber pacer (Medtronics  Selection DR 900E)inserted to control an arrhythmia caused by multiple automatic sites which could not be ablated. 2 weeks later I had a cardiac tamponade. Soon afterward later I was in ER due to tach & was started on sotalol 80mg bid. My tachycardia formerly was very rapid flutters which lasted a short time OR very frequent PAC's. Now it is regular artial tach, ranging from 110-180 and lasts for several hours. My dr has suggested increasing the sotalol and/or ablating the AV node. Could the new tach be caused by scar tissue from the effusion or the pacer wires? After all that has happened I am hesitant to have another procedure.  I am an otherwise healthy, althletic person with a satisfying job and don't function well on betablockers.

What would you advise? Thanks for listening.

[CCF-M.D.-CRC]

Dear DL,

I doubt the tachycardia is due to the pacemaker placement.  More likely the sotalol has stabilized some of the arrhythmias and allowed this one to sustain.  80mg of Sotalol is a very low dose and I would favor increasing this as tolerated.   If this fails or if you are having side-effects I would suggest another ablation attempt at a center with some of the newer high tech mapping equipment.  There are very few arrhythmias coming from the atrium that we are not able to cure with ablation these days.