My heart rate was that slow and I did get a pacemaker. It’s really a non evasive surgery. With a pulse that low your body cannot get the oxygen it needs to feel normal. Normal heart beat is 80 bpm. Yours being 40 is half normal
Rate. This increases the chance of developing blood clots, stroke and death from heart arrhythmias. Please get the pacemaker and you will be so happy you did. By the way I’m 65.