Elderly patients with a heart rate of 40.beats/min with symptoms such as dizziness and fatigue require a pacemaker. Elderly patients with a heart rate of 40 beats per minute should undergo a dynamic electrocardiogram to understand the underlying heart rate of elderly patients. If the heart rate is around 40 beats per minute in the waking state, and accompanied by symptoms related to bradycardia, such as fatigue after activity, chest tightness, dizziness, blackouts, and other symptoms, there are indications for the installation of a pacemaker, and the treatment of pacemaker installation should be carried out in a timely manner. If the patient has a heart rate of 40 beats per minute during sleep and some elevation of the heart rate during wakefulness without bradycardia-related symptoms, pacemaker installation is not necessary and can be treated conservatively with medication. Patients with bradycardia should be evaluated for indications for pacemaker installation under the supervision of a physician, and those with indications should be treated early.