Patient: Sinus bradycardia with atrial fibrillation. Arrhythmia, sometimes fast and sometimes slow, sometimes stopping, the longest stopping time is 2.8 seconds. The longest duration of 2.8 seconds was 367 times in 24 hours on an ambulatory ECG. Is there any other solution for this symptom than to install a pacemaker? Thank you! Chen, Taibo: In the case you described, you should consider the implantation of a permanent pacemaker with medication to control atrial fibrillation, as the slow and fast syndrome type of sick sinus syndrome.