Is it persistant av block 2nd degree type 1 still requiring pacemaker implantation? hr <50 at rest, 50-60 at daytime. dizzy + sob on daily activity.

Heart block: The key here is the presence of symptoms. If the person is experiencing dizziness (which is not due to other causes, many individuals who are athletic have a heart in the 50s and are fine) then treatment should be considered. However, I would suggest that you get a Holter monitoring with precise recording of events: if you feel dizzy then record the time and the circumstances)