A 50-year-old patient gives a history of four dizzy spells in the last month, occurring once a week. When she is seen in the clinic, she is not on any medications, is asymptomatic, and pulse is 45 bpm. The thyroid function is normal. What is the next step in the management?

1. Observe
   
2. 48-h Holter monitor
   
3. Event monitor
   
4. Permanent pacer implant.

A 65-year-old obese male patient with history of hypertension was monitored following colonoscopy. He had sinus bradycardia with heart rate of 45 bpm. A Holter monitor was placed which revealed episodes of second-degree atrioventricular (AV) block with 2 : 1 conduction. The patient did not have any symptoms while he wore the monitor. What is the next step in the management of this patient?

1. Event monitor
   
2. Sleep studies
   
3. Electrophysiology (EP) studies
   
4. Pacer implant

A 42-year-old patient has noticed fatigue after returning from a trip to the East Coast. He had been hiking in the woods. He denies history of syncope. His ECG shows complete heart block. Which of the following options should be considered next?

1. Observe
   
2. Lyme serology
   
3. Temporary pacer
   
4. Permanent pacer

A 35-year-old asymptomatic patient with myotonic muscular dystrophy has evidence of first-degree AV block on a routine ECG. Which option should be considered next?

1. Schedule follow up in 6 months
   
2. Holter monitor
   
3. EP studies
   
4. Permanent pacer implant

In a patient with history of syncope and evidence of right bundle branch block with left anterior fascicular block on one ECG and a right bundle branch block with left posterior fascicular block on an ECG done the following day, what is the next appropriate step?

1. Event monitor
   
2. EP studies
   
3. Loop recorder
   
4. Permanent pacer implant

A 44-year-old patient is status post cardiac transplant 2 days ago. He develops junctional rhythm at 40 bpm. Of the following treatment options, which one is indicated next?

1. Transcutaneous pacing
   
2. Temporary trans-venous pacing
   
3. Permanent pacer implant
   
4. Observe

In patients with cardiac sarcoidosis, which of the following statements is not true?

1. Patients are at risk for developing complete heart block
   
2. Patients are at risk for developing VT
   
3. Myocardial involvement occurs in less than 5% of patients
   
4. Usually affects individuals aged 20–40 years

Which of the following statements regarding carotid sinus hypersensitivity is not true?

1. Elderly patients may present with unexplained falls without loss of consciousness
   
2. The reflex has a cardio-inhibitory component
   
3. There is no vasodepressor component
   
4. Permanent pacing is indicated in patients who develop pause greater than 3.0 s with carotid sinus massage

Which of the following statements regarding the role of pacing in neuro-cardiogenic syncope is not true?

1. It is not the first-line therapy for most patients.
   
2. It is indicated if there is no prodrome before syncopal event
   
3. It is indicated in patients with profound bradycardia or asystole during an episode
   
4. Those patients in whom other therapies are effective, but patient prefers to undergo pacer implant

In patients with long QT syndrome, which of the following is not an indication for permanent pacer implant?

1. Prevent pause-dependent VT, with or without QT prolongation
   
2. In high-risk patients with congenital long QT
   
3. Torsades de pointes VT due to reversible causes
   
4. Combination of pacing and beta blockade shortens QT interval and reduces the risk of sudden cardiac death