is this a true pause in systole (with an escape rhythm) or are you talking about the pause present from ectopic activity?
From what I've seen with other patients, it depends on what is causing the pauses. Most of the time we don't know but if you're having pauses that are causing you to loose consciousness then a pacer or just a defibrillator would be the treatment. IF it's from medication, especially if you're on heart rate control meds like metoprolol or cardizem they need to be changed, as they can cause pauses too. We have patients that get a pacemaker then go home the next day, so the procedure seems pretty low risk. Better than taking the chance of having your heart stop.