Low heart rate and permanent pacemaker insertion

Dear Ask The Doctor: My father is a 76 year old male with history of 5 bypasses and prostate cancer. He has been in Atrial Fib for about a year. Lately his pulse is staying down in 40's with a Blood Pressure elevating up to 180 over 95. Only current change in treatment is adding O2. Is this a major concern?

Dear Jeff:With a past medical history of 5 coronary artery bypass grafts and atrial fibrillation, your father may have significant heart disease affecting the conduction of electricity through the heart. This could be represented by abnormal heart rhythm or a slowed heart rate. A heart rate of 40 beats per minute, is slow but may be adequate, if he is asymptomatic and he may be on beta-blocking medications or alternatives to control heart rate in atrial fibrillation. However if he has symptoms of dizziness, fatigue, light-headedness, or collapse he may benefit from permanent pacemaker insertion. I would advise attending his family physician for an ECG (electrical trace of the heart). Based on this result, and any history of relevant symptoms, he may benefit from referral to a cardiologist for consideration of permanent pacemaker insertion.