@retirement75
I have cardiomyopathy. Diagnosed back in 2001. I had non treated high blood pressure but my cardiologist determined my cardiomyopathy diagnosis as my heart Catherization revealed no signs of cardiovascular disease.

You mentioned the 30 number for recommendation for pacemaker. When I got my recommendation for a 30 EF the recommendation was for ICD not pacemaker. Cardiology stated to me back then (2006) that is the number at EF that a ICD is recommended.

I went to Mayo Jacksonville for second opinion with EP. There the EP agrees with recommendation for ICD but wanted to add pacemaker dual device. Reason is electrical problems caused by virus infection caused scar tissue, LBBB, and conduction delay. EP wanted to have pacemaker to provide heart a continuous and steady pulse with good conduction.

He referred me to heart failure doctor at Mayo. That doctor put me on two new medications that brought my heart rate down into 30s and lowered my BP also. The pacemaker would then be used to pulse my heart to the right rate based on me and what doctors thought was best rate.

The ICD was there to address tachycardia which can happen with low EF. That it where the 30 EF needs ICD but you mentioned them saying pacemaker. I was told ICD needed at 30 EF not a pacemaker. Pacemaker was there to improve electrical function of heart which is common with cardiomyopathy

Are you seeing a electrophysiologist? Are you seeing a heart failure specialist for your EF. A normal EF is 50-70. I would suggest seeing those specialist even if you have to travel. Those specialist will work with your local cardiologist if you cannot see them on regular basis.

So when you get to 30 that is where cardiology says ICD is needed (per Mayo and a local cardiologist who was treating me prior to me changing to Mayo).

You stated your heart rate going up and down which is why pacemaker would provide constant and specific pacing of your heart if needed. The ICD would be statistically recommended when EF reaches 30.

To give you some inspiration. I had my ICD/Pacemaker in 2006. I am on my 3rd device. My EF had gotten to 25 until I was put on two new medications and my ICD/Pacemaker surgery. Since then (almost 20 years now) my EF had remain at 25% and the decrease in EF stopped.

I am very active and have no medical restrictions of exercise other that at 78 try to stay a moderate level which my HF doctor says he would say to any patient who was 78.