Heart Rate of 29 bpm during sleet

[AAF]

I had Holter 24hr. monitoring in 2007 and 2009.  In each,durnig  sleep ( 7 - 8 hrs )  a bpm of 29 was recorded and a number of intervals of 2.8 sec. in 2007 and 3.sec + in 2009. The average bpm was 42 bpm for the 24 hr period. There was no evidence of SVT or VT.  I am essentially asymptomatic.  I am not experiencing any syncope or dizziness,but when climbing a full flight of stairs I can feel the effort, but am not breathless.  I am a 78 yr. old male who has been and still is very active physically lifting weights, walking, bowling and playing golf ( at least trying to).   Is a pacemaker in order now or will it inevitably be required ?  

AAF

[Cleveland Clinic]

It is hard to recommend a pacemaker in your circumstances. I recommend close monitoring of your heart rate but more importantly of your symptoms: if you develop dizziness, lightheadedness, inability to exercise to your capacity then these may all be symptoms of chronotropic incompetence and then benefit from a pacemaker.

[AAF]

Thank you for your response.  I would like to provide some additonal data which I did not include in my initial query for the sake of brevity.  My only medication is a baby aspirin daily. MY resting heart rate is between 45 and 50 bpm.  My remark about not being breathless when climbing was not quite accurate.  Some times I am breathing fairly hard after the climb, and other times I dont feel the effort at all.  On July 2007 I underwent a Technetium-99m Cardolite stress test.  My 85% target was 122 bpm but the atending physician terminated the test at 86 bpm essentially because he thought that I was working too hard.  I was breathing heavily, but was not experiencing any chest pain.  The report stated that there was homogenous uptake of the radiopharmaceutical agent  throughout the left ventricle with no significant change noted between rest and stress.   In March of 2000 I had had the same type of stress test and achieved a max. bpm of 119 which was 9 bpm below the target of 128 but the uptake of the Cardolite was the same as the test in 2007.  There was a homogenous uptake before and after stress.   My cardiologist has recommended a dual chamber, rate-adaptive pacemaker.  When asked why, he expressed concerns about oxygen supply to the brain because of the 30 bpm during sleep.  Is that a valid concern ?   Thank you for your response.