Rate Versus Rhythm Control in a Multimorbid Patient With Tachy–Brady Syndrome: Evaluation of Clinical Outcomes and Pacing Dependency

This case report describes a 77‐year‐old man with multiple comorbidities, including atrial fibrillation, heart failure with mildly reduced ejection fraction, hypertension, diabetes mellitus, and prior coronary artery bypass grafting, who presented with severe hypertension and dyspnoea. The patient was referred for physiologic pacemaker implantation to enable safe and ongoing rate control. Persistent tachy–brady syndrome complicated both rate and rhythm control strategies, ultimately necessitating evaluation for pacemaker implantation. This case highlights the clinical dilemma between rate and rhythm control in multimorbid patients with tachy–brady syndrome and demonstrates how management choices influence pacing dependency and the clinical outcomes.