Does BPM Of 46 Require Pacemaker With Left Shoulder Pain?

Ok... first, pacemakers do not increase life span. What they do is allow someone to have a life at all. So, if someone is finding themselves out on the floor on an hourly or daily or even monthly basis (and driving!) then a pacemaker is a really good idea. It used to be they were put in everytime someone had a heart, but the insurances caught them at it and there are now severe restrictions on that.
The question is whether the arm pain would be fixed with a pacemaker. By itself a REGULAR pulse of 46 can be a sign of very good health and certainly by itself does NOT necessarily indicate a problem (it can be due to a blood pressure medicine that is just working fine). If a stress test doesn't trigger the pain or if the holter shows the arm pain doesn't fit iwth the bpm or if when you move the arm it hurts, then that goes against it being the pulse, cannot say in your particular case without directly examining.