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Slow Heart rhythm
Has coronary artery disease (CAD) been ruled out? It seems you have a number a cardiac risk factors for CAD, assuming your COPD/sleep apnea as related to heavy smoking in your past. These variations in your heart rate - if related to these new symptoms of fatigue and lightheadedness - are definitely something that needs further investigation and probably treatment. The slow heart rates you describe are usually not a cause the symptoms you describe unless you a have poor heart function (you don't). An ejection fraction = 50-55% is essentially normal, and not a reason to be concerned about heart failure and its consequences. If not related to your heart, I'd request an evaluation of your carotid arteries and potential blockages there.
Definitely time to go back to your cardiologist!
Hope this helps,
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