The low EF is likely the reason you are low on energy and tire easily. That said, I do not know how a pacemaker would improve your EF. Do you also have a very slow/low heart rate? This is something that can be treated with a pacemaker.
I know a couple of people who have pacemakers and they do not have any problems with the implanted device. Both are larger people than you, but I think the size of pacemakers continues to shrink. I would suppose that some of the device could be carried outside of the body with a tube/wires going inside to make connection with the heart...just thinking I don't know of any such arrangement, it just seems possible.
There is nothing you said that makes me "think" pacemaker, other than you may suffer from a low heart rate, say under 40 at rest.
If you need a pacemaker I would bet that it will extend you life expectancy. I don't have a number, but do recall general population statistics that say most who are alive at age 66 will live into their 80s. Thus, taking steps to prevent heart failure and to improve you quality of life seems well worth the effort for someone at age 66.
Thank you for your input. I know a friend (a man about 190 lbs) with a different heart problem. His has to do with his arteries (glogging, ect.) and had bypass surgery. My problem is Heart Failure. Which means my heart does not pump properly because my heart is enlarged. My doctor sugested the pacemaker in case my heart would just stop. I guess I look at it when its my time to go I am ok with that. I just don't think I am up to the surgery for the implant.
It is a standard of care for an defibrillator pacer implant for an ejection fraction of < 35%. The risk of lethal arrythmias is higher and if you need a icd, it only has to happen once for it so save your life. They aren't big like the old hockey pucks anymore and are fairly low maintenence. An EF of 20% is not an easy thing. The low bp is part meds and part HF, but if you try to go completely without the meds... your hf will worsen more quickly. No time frame can be clearly delineated as people are entirely individual. That is a quick answer to a hard problem. I walk the same line every day though, so I can say it is so. That and I work on a floor where we do this all the time.
All these people in your family have HEART transplants? WOW! Take care of yourself. I would even recommend a pacer implant. I love mine. As soon as it went in, my heart decided it had enough working on its own anyway. I have been close to fully paced since getting last year. Love the thing. The only thing that gives me more day to day reassurance is my relationship with God. I definitely recommend that too- an ongoing conversation with God. It helps.