More questions, please help

Thank you very much for your reply. Now I have even more questions.

While wearing the holter monitor I had 2  "events" of syncope episodes with a HR 40-43,
While wearing the 30 day event monitor I had 3 "events" of near syncope with the lowest HR of the 3 "events' being 41.    
First became aware of issue was when I awoke at 1AM with mild SOB and dizziness--took my pulse and was 40-41...eventually went to ER. continued dizziness and mild SOB with HR on monitor as low as 35,  Lots of lab tests all norm. EKG=sinus brady.
I was sent home from ER and referred to cardiologist who did all the tests I described without coming to any conclusion yet---other than wanting to place the internal monitor...
I also have history of rheumatic fever; with mild regurg of mitral/tricuspid valve per echo approx 2 years ago.
I'm exhausted, I mean really exhausted.
I'm tired of the "dizzies" and having to either pick myself up off the floor or put myself down onto the floor to avoid crashing to the floor. It's scary to drive--not knowing if I'll get the warning of being dizzy prior to passing out or not.

Medication doesn't sound like a good option...? But what are the options?
Pacemaker IS very much the last resort--- and could it possibly make it worse?

What next?

More testing, if so what test?