It sounds to me like they need to worry a little bit less about the afib for the time being, and focus more on your heart rate and BP. Afib, in and of itself, is not life threatening.

Is this your first episode with afib? How old are you? Do you have any history of heart issues?

A pacemaker for low heart rate is reasonable. But if the low heart rate is due to medications it makes more sense to me to reduce or change medications. Is afib a new diagnosis? There are other options for medications, and rate control vs rhythm control. Is an EP involved in your care? Definitely have an EP opinion before you agree to the pacemaker.

I agree with marikay...Sotalol lowers the HR...I wouldn't get a pacemaker if your low HR is caused by medication. My HR is normally as low as the 50's...when I tried Sotalol, my HR periodically dropped in the 30's as well. I felt like crap on Sotalol, so dropped it after a week.

I had a similar experience in the beginning of this year. I was on Sotalol to treat paroxysmal a-fib and my heart rate went down to 30's. I was also feeling weak and dizzy. I was hospitalized and medication was changed to Tikosyn. It did not end the a-fib episodes but they are not as frequent. Definitely find an EP to recommend treatment that is right for you. I had an option to have AV node ablation plus a pacemaker or a full ablation. I have decided to live with occasional episodes for the time being. Good luck to you. Marya

Thanks for the great posts.
I was dx'ed Jan 2015 with afib. Given Sotalol 80mg and
Warfarin. All seemed ok but lately my HR was about 38 at times and I felt tired and weak.
I am going with the reduced dosage of Sotalol for now and hope it works out. If not I will most likely opt for the pacemaker.

In addition to reducing Sotalol, have you talked to your EP about switching meds? Like Marya, I'm on Tikosyn and feel much better.

Im on Sotalol and it has lowered my hr, too (but not to the 30s! more like the 70s or 80s but then again, I had tachycardia so 70s and 80s are low for me). The thing with Sotalol is that it is an anti-arrhythmic drug with beta blocker qualities. The anti-arrhythmic jumps in when the dose is higher, otherwise you more or less just have a beta blocker. I take 80mg 2 times a day and still get a-fib for about 18 24 hours every 3 4 days. I feel a heck of a better on Sotalol than I did on Metoprolol.
There are other drugs out there ask your EP.

Carpe diem,
across the pond (atp)

I agree with ATP. Don't let your EP convince you that the drugs they're willing to prescribe for you are the only/best options available. When you're talking about something as drastic as a pacemaker, it's best to get a second (or third) opinion.

I understand your concern, I'm in afib right now with a HR going from 49 to 105 all day long, my BP is low as well. it's frightening. My doc doesn't seem to be concerned but I'm freaking out. I see you're on Sotalol, my doc just started me on that plus Eliquis, he took me off the metoprolol that has worked for me for years.
I hope you feel better soon, I'm thinking a pacemaker might be a great alternative to feeling like this, scared and lightheaded.

Thanks to all.
My HR was going from 30 - 130. One ER doc said to try cutting the Sotalol dosage and that sounded like a good plan to me. They cut my dosage to 40mg but no change. My cardio arrived and said reducing the dosage will not work and I needed a pacemaker. They put the pacemaker in yesterday and I just got out of the hospital with my HR now 70. I have been feeling better since the surgery.
As to the surgery, I have been fortunate most of life and seldom had the need for major medical care. Now in my old age it seems I am a hospital frequent flyer and everything scares the hell out of me. I was super worried about the PM but I have faith in my cardio and decided to go with it. Surgery was nothing. Once they started the sedation I could have cared less what they did. Everything went smoothly. This is nothing to worried about if you need a PM. Afterwards the pain was minimal. No more than pain than a pulled muscle. They offered pain meds but I opted for acetaminophen. Today pain is even less. I will post as I progress. IMO now, this surgery is a walk in the park. If you need it just get it done.

Glad it went well and you are feeling better! Please keep us posted on how you are doing!

Glad to hear you are doing well. If I read your first post right You had a low heart rate before you went into afib? If so, that makes sense. The pacemaker was done to treat the problem of the low heart rate not the afib. A pacemaker isn't a standard treatment for afib.