My younger brother 17, has been diagnosed with sick sinus syndrome, with recorded long sinus pause of 2.46 secs in december and 5.9secs in february, prior to these pauses he had recurrent syncopes. But during the recording of these pauses he did not suffer from any syncope, he has not had any syncope from january 2017. Our cardio told us that he requires a pacemaker (DDDR) to act as a safety mechanism if any further syncopes occur. We (family) and he is totally unwilling of the procedure. Is it totally necessary? Or will he die without the pacemaker?