@kb49
Are you seeing a Electrophysiologist (EP). If not you should be. They are the cardiologist experts in electricl functions of heart.

My experience with this is I have had a ICD/Pacemaker since 2006. I am on my 3rd one. I think everything that can go wrong and what you can experience I have gone through.

Most of the time a ICD is recommended when EF gets around 30. This is what my cardioloigsts and EP gave me as guidelines. Now of course many other things could require a ICD not just a low EF.

A pacemaker is to keep the heart beating at a certain rate. Mine keeps my heart rate (HR) from going below 70 and not above 160. I am on medication that without a pacemaker my HR would be in 30s. That was causing a lot of PVCs and arrympthmias.

You stated you have a low heart rate. If too low that would be where most cardioloigst would recommend a pacemaker. Some with very low HR can be dizzy, lack energy, and prone to arrymthmias and tachacardia. This comes from my EP not me as far from a medical expert.

If I read your post correctly you had low heart rate and high blood pressure. Since we don't have your medical and mental health history which your doctors do those reasons and anything else you should discuss with your medical doctors who do know your mental and medical history.

I was seeing a regular cardiologist when he suggested the pacemaker. I then went to Mayo Jacksonville for a second opinion. I had an hour office visit with a EP who not only recommended a ICD but the pacemaker as well. He then referred me to May Jackonville heart failure doctor who concurred with EP but recommended changing my medications.

At that point I turned my medical treatment over to Mayo and follow their recommendattions. That was almost 25 years ago. My EF has remained steady for last 10 years and I am very active physically exercising 6 days a week for 1-2 hours.

By the way the surgery to have it put in is consider minor sugery. Most probably you will go home the same day. I have had three surgeries and another upcoming one in 2-3 years.