Sorry to here to have not had any success with medications. Have you attempted Corlanor? I have POTS and do have a pacemaker. The pacemaker was life changing for me. Although it stopped the syncope, it did not stop the presyncope symptoms. A combination of pacemaker and Corlanor has been a success for me. Note: I had pacemaker placed before dx of POTS for heart pauses and sick sinus syndrome. I think it is hard to get a pacemaker approved for dx of POTS alone.