The need for a pacemaker in an eighty year old patient with a heart rate of 40 beats per minute needs to be determined on the basis of the patient’s own condition. For patients with sinus bradycardia, sick sinus node syndrome, and third-degree atrioventricular block, a heart rate of 40 beats/minute and symptoms such as dizziness and fatigue need to be treated with a pacemaker, or else their lives may be in danger. For patients diagnosed with sinus bradycardia and sick sinus node syndrome, but without palpitations (rapid heartbeat, often accompanied by panic), reduced exercise tolerance and other manifestations, they can continue to be observed and not be given a pacemaker for the time being. Note: If you find yourself or someone around you with a heart rate of 40 beats/minute, regardless of age, it is recommended that you go to the hospital immediately to have your condition clarified for treatment.