Greetings. Thank you for your question and welcome to HCM. I carefully read your query.
Normal
heart rate in the population worldwide is standardized to 60-100 heart beats per minute. Indeed, sportsmen and those who have had vigorous physical activity throughout life have lower heart beat figures, but it is accepted down to 48 beats per minute. In some cases, during rest or sleep even down to 45 beats per minute.
However, when there is bradicardia, lower than these figures, that also produces symptoms such as
dizziness,
fatigue, weakness or blurry or dark vision, some other tests should be undertaken and the pacemaker
implantation indication should be taken into consideration. In your case, from my experience, I would comment a heart beat of 45 beats per minute as normal, if I would find absence of the above described symptoms. Therefore, I would recommend you to be put on a 24- or 48-hour Holter rhythm monitor registration, to see your heart rate to how low it goes during various moments in a day, and if there is any conduction disturbance some time in a day. If there are lower than 40 beat per minute episodes, and the symptoms persist, then pacemaker implantation is indicated. You can further discuss this with your treating cardiologist.
I hope I have been of help.
Best regards,
Dr. Meriton