###Human: How can pacemaker affect arrythmia? ###Assistant: Hi. The rate in AF is controlled with beta blockers, calcium channel blocker or Digoxin. You are taking Sotalol which is a beta blocker as well as the anti-arrhythmic drug. The permanent pacemaker is implanted when there is tachy-brady syndrome. It means sometimes there is tachycardia episode and sometimes bradycardia episode. If we control tachycardia, during bradycardia episode there will be even more severe bradycardia and if we control bradycardia, tachycardia episode will be severe. So, in this situation, a pacemaker is implanted to avoid bradycardia, and for the tachycardia, medicine is continued. The pacemaker is programmed to pace the heart when the rate drops to a certain threshold such as 60 bpm. Paroxysmal AF is one in which rhythm is restored to sinus within seven days, persistent is seven days to 12 months, long-standing persistent is more than 12 months. Cryoablation technique is used to revert rhythm back to normal sinus. It is done in paroxysmal AF, but some trials exist even for persistent and long-standing persistent AF as successful ablation can be done. Please consult your cardiac electrophysiologist about the possibility of this procedure in your case.