Hello. Thank you for using HCM. I read your query. I understand your concern. Normal heart rate is between 60-100. It can be considered normal down to 48-60 beats per minute in sportsmen and in subjects with everyday, vigorous physical activity. A heart rate of 39 beats per minute is considered low. Some medications that are used for controlling high blood pressure, such as beta-blockers, verapamil, diltiazem, as well as digoxin for controlling the heart rate, can cause slowing of heart rate when their dosage is higher than needed. My opinion is that you should be put on a 24-hour Holter rhythm monitor, to see if this was a one-time episode or it is constant at these figures. If you are not on above mentioned medication and the Holter rhythm show that your heart rate is constantly about 40 beats per minute, combined with clinical symptoms such as dizziness or fatigue, then pacemaker implantation is indicated. I hope I was helpful with my answer. Best regards.