I am 53 years old and 5 years ago I had a Medtronic two lead pacemaker installed for complete heart block that came out of nowhere. I am paced 100% of the time.The only meds I take is 100mg of Cozaar for blood pressure. My doctor does an echo on me about every year or so. My last echo two years ago my EF was 50-55% which is where it normally is. This past May my EF was 45-50%. My doctor suggested that I get a third lead added to help keep my EF from continuing to lower. I asked for a second test to confirm that my EF had gone down. So we did a nuclear stress test in June which showed my EF was 65% but that I may have a blockage. So I had a catheterization done and thankfully I didn't have any blockages. My doctor wanted to do a follow-up echo in six months to recheck my EF. I had that done last week and it showed my EF between 45-50%. He again suggested that I have a third lead added to help my EF. Keep in mind that the echo didn't show anything remarkable other then the EF. I really don't want a third lead added if I can avoid it but I am not sure at this point what to do. I am fairly active hiking and mountain biking. lately I have been feeling really tired but not out of breath after riding moderate trails for about an hour.