Cardiac pacing, resynchronization and defibrillation

1. Question

In patients with syncope of unknown origin compatible with a reflex mechanism or with symptoms related to pressure/manipulation of the carotid sinus area, what is recommended once carotid stenosis is ruled out?

1. Immediate pacemaker implantation
2. Carotid sinus massage (CSM)
3. Coronary angiography
4. Echocardiography
5. Tilt-table testing

2. Question

In the evaluation of patients with suspected bradycardia, what is recommended to correlate rhythm disturbances with symptoms?

1. Echocardiography
2. Stress testing
3. Ambulatory ECG monitoring
4. Cardiac MRI
5. Electrophysiological study

3. Question

What is the recommended investigation for patients who experience symptoms suspicious of bradycardia during or immediately after exertion?

1. Ambulatory 3-lead ECG recording
2. Exercise stress test
1. Ambulatory 12-lead ECG recording
4. Electrophysiological testing
5. Myocardial SPECT

4. Question

In patients with suspected chronotropic incompetence, what should be considered to confirm the diagnosis?

1. Regular blood pressure monitoring
2. Genetic testing
3. Exercise testing
4. Echocardiogram
5. Holter monitoring

5. Question

In patients with intraventricular conduction disease or AVB of unknown level, what may be considered to expose infranodal block?

1. Echocardiography
2. MRI
3. Exercise testing
4. CT scan
5. Holter monitoring

6. Question

Which of the following is recommended for patients with suspected or documented symptomatic bradycardia to evaluate the presence of structural heart disease, determine LV systolic function, and diagnose potential causes of conduction disturbances?

1. Genetic testing
2. Cardiac imaging
3. Routine blood tests
4. Electrophysiological study
5. Stress testing

7. Question

In the diagnosis of specific pathologies associated with conduction abnormalities needing pacemaker implantation, particularly in patients younger than 60 years, which imaging modalities should be considered for myocardial tissue characterization?

1. Echocardiography, X-ray, MRI
2. CMR, CT, PET
3. Ultrasound, CT, PET
4. CMR, X-ray, MRI
5. PET, MRI, Ultrasound

8. Question

Which specific laboratory tests are recommended for patients with clinical suspicion of potential underlying causes of reversible bradycardia?

1. Complete blood count, liver function tests, and urinalysis
2. Thyroid function tests, Lyme titre, digitalis level, potassium, calcium, and pH
3. Blood glucose, lipid profile, and renal function tests
4. Hemoglobin A1c, vitamin D level, and electrolytes
5. Liver enzymes, creatinine, and blood urea nitrogen

9. Question

In patients with early onset (age <50 years) of progressive cardiac conduction disease, what is the recommendation for genetic testing?

1. Genetic testing should be considered.
2. Genetic testing should be avoided.
3. Genetic testing is mandatory.
4. Genetic testing is not recommended.
5. Genetic testing should be delayed until age 50.

10. Question

In the context of cardiac conduction disease, under what circumstance should genetic testing be considered for family members?

1. When an index case has a family history of other cardiovascular diseases.
2. After the identification of a pathogenic genetic variant that explains the clinical phenotype of cardiac conduction disease in an index case. *
3. When family members exhibit symptoms of cardiac conduction disease.
4. Routinely for all family members regardless of any genetic findings.
5. Only if the index case is asymptomatic.

11. Question

In which of the following situations is screening for Sleep Apnea Syndrome (SAS) recommended according to clinical practice guidelines?

1. In patients with mild bradycardia during sleep
2. In patients with symptoms of SAS and in the presence of severe bradycardia or advanced AV block (AVB) during sleep*
3. In patients with no symptoms of SAS but with severe bradycardia during sleep
4. In patients with advanced AV block (AVB) during the day
5. In patients with mild AV block (AVB) during sleep

12. Question

In patients with suspected recurrent reflex syncope, what diagnostic test should be considered?

1. Electrocardiogram (ECG)
2. Echocardiogram
3. Tilt testing*
4. Holter monitoring
5. Cardiac MRI

13. Question

In patients with infrequent (less than once a month) unexplained syncope or other symptoms suspected to be caused by bradycardia, in whom a comprehensive evaluation did not demonstrate a cause, what is recommended for long-term ambulatory monitoring?

1. Holter monitor
2. Event recorder
3. Pacemaker
4. Implantable loop recorder (ILR)*
5. External loop recorder

14. Question

In patients with syncope and bifascicular block, when should an electrophysiology study (EPS) be considered?

1. Only if the patient is under 60 years old.
2. When syncope remains unexplained after non-invasive evaluation or when an immediate decision about pacing is needed due to severity.
3. Only if the patient has a history of heart failure.
4. If the patient has had multiple episodes of syncope within the past month.
5. When syncope is accompanied by chest pain.

15. Question

In patients with syncope and sinus bradycardia, when should an electrophysiology study (EPS) be considered?

1. When there is a clear correlation between syncope and bradycardia.
2. When non-invasive tests have confirmed the diagnosis of syncope.
3. When non-invasive tests have failed to show a correlation between syncope and bradycardia.*
4. When syncope occurs without any other underlying heart condition.
5. When the patient has a history of atrial fibrillation.

16. Question

In patients with sinus node dysfunction (SND) and a DDD pacemaker, what is recommended to minimize unnecessary ventricular pacing?

1. Increase the pacing rate
2. Minimize the pacing duration
3. Adjust the programming to minimize unnecessary ventricular pacing*
4. Use a VVI pacemaker instead of a DDD pacemaker
5. Turn off the pacemaker

17. Question

In the context of sinus node dysfunction (SND), when is pacing indicated?

1. When symptoms are intermittent and not clearly related to bradyarrhythmias.
2. When symptoms can clearly be attributed to bradyarrhythmias.*
3. When there is asymptomatic bradycardia.
4. When there is a family history of bradyarrhythmias.
5. When symptoms are mild and infrequent.

18. Question

In symptomatic patients with the bradycardia-tachycardia form of sinus node dysfunction (SND), when is pacing indicated?

1. Only after ablation of the tachyarrhythmia has been attempted.
2. To correct bradyarrhythmias and enable pharmacological treatment, unless ablation of the tachyarrhythmia is preferred.*
3. Only if pharmacological treatment is ineffective.
4. When bradyarrhythmias are present without any tachyarrhythmia.
5. Exclusively for asymptomatic patients to prevent potential complications.

19. Question

Which type of pacemaker should be considered for patients with chronotropic incompetence and clear symptoms during exercise?

1. VVI pacemaker
2. AAI pacemaker
3. DDD pacemaker without rate-responsive pacing
4. DDD pacemaker with rate-responsive pacing*
5. CRT pacemaker

20. Question

In patients with AF-related bradycardia or symptomatic pre-automaticity pauses, what strategy should be considered to avoid pacemaker implantation, taking into account the clinical situation?

1. Medication adjustment
2. AF ablation*
3. Permanent pacemaker implantation
4. Cardiac resynchronization therapy
5. Lifestyle modification

21. Question

In patients with the bradycardia-tachycardia variant of SND, what intervention may be considered according to clinical practice guidelines?

1. Programming of ventricular ATP
2. Programming of atrial ATP*
3. Use of beta-blockers
4. Implantation of a dual-chamber pacemaker
5. Administration of anti-arrhythmic drugs

22. Question

In patients with syncope, cardiac pacing may be considered to reduce recurrent syncope when which of the following conditions is documented?

1. Asymptomatic pause(s) >4 s due to sinus arrest
2. Asymptomatic pause(s) >5 s due to sinus arrest
3. Asymptomatic pause(s) >6 s due to sinus arrest*
4. Symptomatic pause(s) >6 s due to sinus arrest
5. Asymptomatic pause(s) >6 s due to atrial fibrillation

23. Question

Under what condition may pacing be considered in patients with sinus node dysfunction (SND), according to the guideline recommendation?

1. When symptoms are likely due to bradyarrhythmias, and the evidence is conclusive.
2. When symptoms are likely due to bradyarrhythmias, even if the evidence is not conclusive.*
3. When symptoms are unlikely to be due to bradyarrhythmias, and the evidence is not conclusive.
4. When there are no symptoms but the evidence is conclusive.
5. When symptoms are likely due to tachyarrhythmias, even if the evidence is not conclusive.

24. Question

In patients with sinus node dysfunction (SND), under which condition is pacing not recommended?

1. In patients with symptomatic bradyarrhythmias related to SND.
2. In patients with asymptomatic bradyarrhythmias related to SND.*
3. In patients with bradyarrhythmias related to SND that are due to transient causes.
4. In patients with bradyarrhythmias related to SND that are due to transient causes that can be corrected and prevented.*
5. In patients with asymptomatic bradyarrhythmias related to SND that are not due to transient causes.

25. Question

In patients with atrioventricular block, which condition would indicate the need for pacing irrespective of symptoms?

1. First-degree atrioventricular block
2. Second-degree type 1 atrioventricular block
3. Second-degree type 2 atrioventricular block*
4. Mobitz I atrioventricular block
5. Wenckebach atrioventricular block

26. Question

In patients with atrial arrhythmia (mainly AF) and permanent or paroxysmal third- or high-degree AVB, when is pacing indicated?

1. Only when symptoms are present
2. Only in the presence of permanent AVB
3. Only in the presence of paroxysmal AVB
4. Irrespective of symptoms*
5. Only in patients without symptoms

27. Question

In patients with permanent atrial fibrillation (AF) in need of a pacemaker, which type of pacing is recommended?

1. Atrial pacing with rate-response function
2. Dual-chamber pacing with rate-response function
3. Ventricular pacing without rate-response function
4. Atrial pacing without rate-response function
5. Ventricular pacing with rate-response function*

28. Question

In which of the following scenarios should pacing be considered for patients with second-degree type 1 AVB (atrioventricular block)?

1. When the patient is asymptomatic and the block is located above the His bundle.
2. When the patient shows symptoms or the block is found at intra- or infra-His levels during EPS.*
3. When the patient has first-degree AVB with no symptoms.
4. When the patient has third-degree AVB and is asymptomatic.
5. When the patient has second-degree type 2 AVB without symptoms.

29. Question

In patients with atrioventricular block (AVB), what type of pacing should be preferred to avoid pacemaker syndrome and improve quality of life?

1. Single chamber atrial pacing
2. Single chamber ventricular pacing
3. Dual chamber pacing (DDD)*
4. Biventricular pacing
5. No pacing

30. Question

In patients with persistent symptoms similar to those of pacemaker syndrome and clearly attributable to first-degree AVB (PR >0.3 s), what should be considered?

1. Medication adjustment
2. Permanent pacemaker implantation*
3. Lifestyle modification
4. Temporary pacemaker implantation
5. Electrophysiological study

31. Question

According to the clinical practice guidelines, in which situation is pacing not recommended for patients with atrioventricular block (AVB)?

1. In patients with AVB due to transient causes that can be corrected and prevented.*
2. In patients with AVB due to permanent causes.
3. In patients with AVB and symptomatic bradycardia.
4. In patients with AVB and heart failure.
5. In patients with AVB and syncope.

32. Question

In patients with unexplained syncope and bifascicular block, which of the following conditions indicate the need for a pacemaker?

1. A baseline HV interval of 50 ms
2. Second- or third-degree intra- or infra-Hisian block during incremental atrial pacing*
3. A baseline HV interval of 40 ms
4. An abnormal response to physical exercise
5. First-degree intra- or infra-Hisian block during incremental atrial pacing

33. Question

In patients with bundle branch block (BBB), under what condition is pacing indicated?

1. Only in patients with alternating BBB who exhibit symptoms.
2. In all patients with BBB regardless of symptoms.
3. Only in patients with persistent BBB without symptoms.
4. Pacing is not indicated in patients with alternating BBB.
5. In patients with alternating BBB with or without symptoms.*

34. Question

In which of the following scenarios may pacing be considered for patients with unexplained syncope and bifascicular block without EPS?

1. Young patients with infrequent syncope
2. Elderly, frail patients with high-risk and/or recurrent syncope*
3. Patients with no history of syncope
4. Adolescent athletes with bifascicular block
5. Middle-aged patients with transient syncope

35. Question

Based on the clinical practice guidelines, what is the recommendation for pacing in patients with asymptomatic bundle branch block (BBB) or bifascicular block?

1. Pacing is recommended for all patients with BBB.
2. Pacing is recommended for asymptomatic BBB.
3. Pacing is recommended for symptomatic BBB only.
4. Pacing is not recommended for symptomatic BBB.
5. Pacing is not recommended for asymptomatic BBB or bifascicular block.*

36. Question

In patients aged >40 years with severe, unpredictable, recurrent syncope, which of the following conditions indicate the use of dual-chamber cardiac pacing to reduce recurrent syncope?

1. Spontaneous documented symptomatic asystolic pause >2 s or asymptomatic pause >5 s due to sinus arrest or AVB
2. Cardiostimulatory carotid sinus syndrome
3. Asystolic syncope during exercise testing
4. Spontaneous documented symptomatic asystolic pause >3 s or asymptomatic pause >6 s due to sinus arrest or AVB*
5. Hypertrophic cardiomyopathy with syncope

37. Question

According to clinical practice guidelines, which intervention may be considered to reduce syncope recurrences in patients with the clinical features of adenosine-sensitive syncope?

1. Single-chamber cardiac pacing
2. Dual-chamber cardiac pacing*
3. Beta-blocker therapy
4. Implantable cardioverter-defibrillator (ICD)
5. Lifestyle modifications

38. Question

For patients with reflex syncope, when is cardiac pacing indicated according to clinical practice guidelines?

1. In the presence of a documented cardioinhibitory reflex.*
2. In the absence of a documented cardioinhibitory reflex.
3. Only if the patient has experienced more than three episodes of syncope.
4. Automatically for all patients diagnosed with reflex syncope.
5. When other treatments have failed.

39. Question

In patients with recurrent unexplained falls, what assessment should be considered?

1. Standard fall risk assessment
2. Neurological evaluation
3. Same assessment as for unexplained syncope*
4. Orthopedic evaluation
5. Routine blood tests

40. Question

In patients with unexplained falls and no other documented indication, what is the recommendation regarding cardiac pacing?

1. Pacing is strongly recommended.
2. Pacing is recommended only in the presence of syncope.
3. Pacing is not recommended.*
4. Pacing should be considered if other treatments fail.
5. Pacing is recommended as a preventive measure.

41. Question

In patients with unexplained syncope without evidence of SND or conduction disturbance, what is the guideline recommendation regarding cardiac pacing?

1. Pacing is recommended.
2. Pacing is recommended only if other treatments fail.
3. Pacing is recommended based on patient preference.
4. Pacing is not recommended.*
5. Pacing is recommended only in the presence of comorbid conditions.

42. Question

In patients with heart failure, sinus rhythm, LVEF 35%, QRS duration 150 ms, and LBBB QRS morphology despite optimal medical therapy, what is the recommended treatment to improve symptoms and reduce morbidity and mortality?

1. Implantable cardioverter-defibrillator (ICD) implantation
2. Cardiac resynchronization therapy (CRT)
3. Coronary artery bypass grafting (CABG)
4. Percutaneous coronary intervention (PCI)
5. Medical management only

43. Question

In patients with heart failure (HF) in sinus rhythm (SR) with left ventricular ejection fraction (LVEF) 35%, a QRS duration of 130149 ms, and left bundle branch block (LBBB) QRS morphology despite optimal medical therapy (OMT), what is the recommended treatment to improve symptoms and reduce morbidity and mortality?

1. Beta-blockers
2. Implantable cardioverter-defibrillator (ICD)
3. Cardiac resynchronization therapy (CRT)*
4. Coronary artery bypass grafting (CABG)
5. Angiotensin-converting enzyme (ACE) inhibitors

44. Question

Under which conditions should cardiac resynchronization therapy (CRT) be considered for symptomatic patients with heart failure (HF) in sinus rhythm (SR) with non-LBBB QRS morphology?

1. LVEF 35%, QRS duration 150 ms, and non-LBBB QRS morphology despite optimal medical therapy (OMT), in order to improve symptoms and reduce morbidity.*
2. LVEF >35%, QRS duration >120 ms, and LBBB QRS morphology despite OMT, in order to reduce mortality.
3. LVEF 35%, QRS duration <150 ms, and non-LBBB QRS morphology despite OMT, in order to improve symptoms.
4. LVEF 40%, QRS duration 150 ms, and LBBB QRS morphology despite OMT, in order to reduce hospitalization.
5. LVEF 30%, QRS duration 120 ms, and non-LBBB QRS morphology with no OMT, in order to improve survival.

45. Question

In patients with heart failure (HF) in sinus rhythm (SR) and non-LBBB QRS morphology, under what conditions may cardiac resynchronization therapy (CRT) be considered to improve symptoms and reduce morbidity?

1. LVEF 35%, QRS duration 130149 ms, despite optimal medical therapy (OMT)
2. LVEF 40%, QRS duration 120150 ms, despite optimal medical therapy (OMT)
3. LVEF 35%, QRS duration 130149 ms, and LBBB QRS morphology despite OMT
4. LVEF 30%, QRS duration 120140 ms, despite optimal medical therapy (OMT)
5. LVEF 35%, QRS duration 130149 ms, and non-LBBB QRS morphology despite OMT*

46. Question

In patients with heart failure (HF) and a QRS duration of less than 130 milliseconds (ms) without an indication for right ventricular (RV) pacing, which of the following is the appropriate recommendation regarding cardiac resynchronization therapy (CRT)?

1. CRT is recommended.
2. CRT is indicated only if the patient shows symptoms of severe HF.
3. CRT is not indicated.*
4. CRT is recommended only if the patient is not responding to medication.
5. CRT is indicated if the patient has a history of arrhythmias.

47. Question

In patients with heart failure (HF) and permanent atrial fibrillation (AF) who have a left ventricular ejection fraction (LVEF) 35% and are in NYHA class III or IV despite optimal medical therapy (OMT), what is the criterion for considering cardiac resynchronization therapy (CRT)?

1. AF duration more than 1 year
2. Intrinsic QRS duration 130 ms*
3. NYHA class II symptoms
4. LVEF >35%
5. Antiarrhythmic drug intolerance

48. Question

In patients with heart failure and permanent atrial fibrillation who are candidates for cardiac resynchronization therapy (CRT), what should be added in case of incomplete biventricular pacing (<9095%) due to conducted AF?

1. Beta-blocker therapy
2. AVJ ablation*
3. Anticoagulation therapy
4. Rate control medication
5. Antiarrhythmic drugs

49. Question

In patients with symptomatic atrial fibrillation and an uncontrolled heart rate who are candidates for AVJ ablation, what is recommended for those with HFrEF?

1. Beta-blockers
2. Diuretics
3. Cardiac resynchronization therapy (CRT)*
4. Anticoagulants
5. Pacemaker implantation

50. Question

In patients with symptomatic AF and an uncontrolled heart rate who are candidates for AVJ ablation (irrespective of QRS duration), what should be considered instead of standard RV pacing in patients with HFmrEF?

1. CRT should be avoided
2. CRT should be considered
3. CRT should only be used if QRS duration is prolonged
4. CRT is not recommended
5. CRT rather than standard RV pacing should be considered*

51. Question

In patients with symptomatic atrial fibrillation (AF) and an uncontrolled heart rate who are candidates for AVJ ablation, what should be considered in patients with heart failure with preserved ejection fraction (HFpEF)?

1. LV pacing
2. Biventricular pacing
3. RV pacing*
4. His bundle pacing
5. No pacing

52. Question

In patients with symptomatic AF and an uncontrolled heart rate who are candidates for AVJ ablation (irrespective of QRS duration), which therapy may be considered in patients with HFpEF?

1. ICD therapy
2. Beta-blocker therapy
3. CRT therapy*
4. Digoxin therapy
5. Anticoagulant therapy

53. Question

According to clinical practice guidelines, which patients should be considered for an upgrade from a conventional pacemaker or ICD to cardiac resynchronization therapy (CRT)?

1. Patients with LVEF >50% and no symptoms of heart failure
2. Patients with LVEF 35% and symptomatic heart failure despite optimal medical therapy (OMT) with a significant proportion of right ventricular (RV) pacing*
3. Patients with asymptomatic heart failure and LVEF 35%
4. Patients with LVEF 45% and no RV pacing
5. Patients with LVEF 35% and no heart failure symptoms

54. Question

According to the clinical practice guidelines, for which patients is Cardiac Resynchronization Therapy (CRT) recommended over Right Ventricular (RV) pacing to reduce morbidity?

1. Patients with HFrEF (<40%) and NYHA class I only
2. Patients with HFrEF (<40%) regardless of NYHA class who have an indication for ventricular pacing and high degree AVB, including those with AF*
3. Patients with preserved EF (>50%)
4. Patients with HFrEF (<40%) and NYHA class IV only
5. Patients without any form of heart failure

55. Question

In patients who are candidates for an ICD and who have CRT indication, what is recommended?

1. Implantation of a CRT-P
2. No intervention
3. Medical therapy only
4. Implantation of a CRT-D*
5. Implantation of a pacemaker

56. Question

In patients who are candidates for CRT, what should be considered after individual risk assessment and using shared decision-making?

1. Implantation of a CRT-P
2. Implantation of a CRT-D*
3. Pharmacological therapy
4. Surgical intervention
5. Lifestyle modification

57. Question

In patients treated with His bundle pacing (HBP), what is recommended for device programming?

1. Device programming should follow standard procedures for all pacemakers.
2. Device programming should minimize battery usage regardless of pacing requirements.
3. Device programming should be tailored to the specific requirements of HBP.*
4. Device programming should prioritize atrial pacing over ventricular pacing.
5. Device programming should be set to default factory settings.

58. Question

In CRT candidates in whom coronary sinus lead implantation is unsuccessful, which treatment option should be considered along with other techniques such as surgical epicardial lead?

1. Atrial septal pacing
2. His bundle pacing*
3. Right ventricular pacing
4. Left ventricular pacing
5. Dual chamber pacing

59. Question

In patients treated with His bundle pacing (HBP), in which of the following specific situations should the implantation of a right ventricular (RV) lead used as “backup” for pacing be considered?

1. Patients with complete left bundle branch block.
2. Patients with high grade atrioventricular block (AVB).
3. Patients without any pacing dependency.
4. Patients with stable sinus rhythm.
5. Patients undergoing routine ECG monitoring.

60. Question

In which patient scenario is His bundle pacing (HBP) with a ventricular backup lead considered according to the guideline recommendations?

1. Patients with bradycardia and wide QRS complex
2. Patients with heart failure with reduced ejection fraction
3. Patients with rapidly conducted supraventricular arrhythmia and a narrow intrinsic QRS*
4. Patients with chronic atrial fibrillation
5. Patients requiring cardiac resynchronization therapy (CRT)

61. Question

In patients with AVB and an LVEF greater than 40%, who are anticipated to have more than 20% ventricular pacing, what alternative to RV pacing may be considered?

1. CRT (Cardiac Resynchronization Therapy)
2. ICD (Implantable Cardioverter Defibrillator)
3. HBP (His Bundle Pacing) *
4. CRT-D (Cardiac Resynchronization Therapy-Defibrillator)
5. AV node ablation

62. Question

Under which circumstances should leadless pacemakers be considered as an alternative to transvenous pacemakers?

1. When there is a history of heart failure.
2. When the patient has a high risk of arrhythmias.
3. When no upper extremity venous access exists or when the risk of device pocket infection is particularly high, such as previous infection and patients on hemodialysis.*
4. When the patient requires dual-chamber pacing.
5. When the patient has a history of myocardial infarction.

63. Question

Under what conditions may leadless pacemakers be considered as an alternative to standard single-lead ventricular pacing?

1. Only in cases of acute myocardial infarction.
2. When the patient has a history of atrial fibrillation.
3. Taking into consideration life expectancy and using shared decision-making.*
4. As a first-line treatment for all patients with bradycardia.
5. Exclusively for patients with a high risk of infection.

64. Question

In the context of recommendations for cardiac pacing after acute myocardial infarction, what is the indicated course of action if atrioventricular block (AVB) does not resolve within a waiting period of at least 5 days after MI?

1. Immediate implantation of a permanent pacemaker
2. Wait for 10 days before considering pacemaker implantation
3. Implantation of a temporary pacemaker
4. Implantation of a permanent pacemaker with the same recommendations as in a general population*
5. Routine follow-up without pacemaker implantation

65. Question

In selected patients with AVB in the context of anterior wall MI and acute HF, what type of early device implantation may be considered?

1. ICD
2. CRT-D
3. CRT-P
4. CRT-D/CRT-P*
5. Pacemaker

66. Question

When is cardiac pacing not recommended after an acute myocardial infarction?

1. After ventricular fibrillation is corrected
2. If atrioventricular block (AVB) resolves after revascularization or spontaneously*
3. When there is persistent bradycardia
4. If atrial fibrillation is diagnosed
5. After administration of anticoagulants

67. Question

How long is the recommended period of clinical observation for assessing whether high-degree or complete AVB after cardiac surgery is transient and resolves?

1) 3 days
2) 5 days*
3) 7 days
4) 10 days
5) 14 days

68. Question

In patients undergoing surgery for valvular endocarditis and complete AV block, which of the following predictors would indicate the need for immediate epicardial pacemaker implantation?

1. Preoperative conduction abnormality
2. Hypertension
3. Diabetes mellitus
4. Left ventricular hypertrophy
5. Age over 65 years

69. Question

According to clinical practice guidelines, what should be considered before permanent pacemaker implantation for sinus node dysfunction (SND) after cardiac surgery and heart transplantation?

1. Immediate implantation of a permanent pacemaker
2. Observation period of up to 2 weeks
3. Observation period of up to 4 weeks
4. Observation period of up to 6 weeks*
5. No observation period required

70. Question

What is the recommended course of action for chronotropic incompetence persisting for more than 6 weeks after heart transplantation?

1. Immediate cardiac pacing after heart transplantation
2. Cardiac pacing should be considered to improve quality of life*
3. No intervention required
4. Use of medication to manage chronotropic incompetence
5. Regular monitoring without intervention

71. Question

Which of the following recommendations is correct regarding pacemaker lead management during tricuspid valve surgery?

1) Transvalvular leads should be preferred and epicardial ventricular leads avoided.
2) Transvalvular leads should be avoided and epicardial ventricular leads used.*
3) Pre-existing transvalvular leads should always be left in place during tricuspid valve surgery.
4) During tricuspid valve surgery, sewing-in the lead between the annulus and a bioprosthesis is the recommended approach.
5) During isolated tricuspid annuloplasty, a pre-existing RV lead must always be jailed between the ring and annulus.

72. Question

When ventricular pacing is indicated for patients after biological tricuspid valve replacement/tricuspid valve ring repair, which implantation approach should be considered and preferred?

1. Transvenous transvalvular approach
2. Surgical placement of an atrial lead
3. Transvenous implantation of a coronary sinus lead*
4. Open-heart placement of an endocardial lead
5. Minimally invasive placement of a subcutaneous lead

73. Question

What is the recommendation for patients requiring pacing after mechanical tricuspid valve replacement?

1. Implantation of a transvalvular RV lead should be avoided.*
2. Implantation of an atrial lead is recommended.
3. Implantation of a transvalvular RV lead is mandatory.
4. Implantation of a left ventricular lead should be avoided.
5. Implantation of a transvalvular atrial lead should be considered.

74. Question

In patients who have undergone transcatheter aortic valve implantation (TAVI), what is recommended for those with complete or high-degree atrioventricular block (AVB) that persists for 24-48 hours?

1. Temporary pacing is recommended.
2. No pacing is required.
3. Monitoring for another 24 hours is recommended.
4. Permanent pacing is recommended.
5. Immediate surgery is recommended.

75. Question

In patients with new-onset alternating BBB after TAVI, what is recommended for cardiac pacing?

1. Temporary pacing
2. No pacing required
3. Monitoring with follow-up ECGs
4. Permanent pacing
5. Medication management

76. Question

In which patient population should early permanent pacing be considered after transcatheter aortic valve implantation (TAVI)?

1. Patients with pre-existing left bundle branch block (LBBB) who develop any further conduction disturbance during or after TAVI
2. Patients without any conduction disturbances before TAVI
3. Patients with pre-existing right bundle branch block (RBBB) who develop any further conduction disturbance during or after TAVI*
4. Patients with newly diagnosed atrial fibrillation after TAVI
5. Patients with pre-existing complete heart block before TAVI

77. Question

What should be considered for patients with new LBBB with QRS >150 ms or PR >240 ms with no further prolongation during the >48 h after TAVI?

1. Immediate pacemaker implantation
2. Discharge without further monitoring
3. Ambulatory ECG monitoring or EPS*
4. Repeat TAVI procedure
5. Surgical aortic valve replacement

78. Question

What monitoring or procedure may be considered for patients with a pre-existing conduction abnormality who develop prolongation of QRS or PR >20 ms after transcatheter aortic valve implantation?

1. Routine echocardiography
2. Ambulatory ECG monitoring*
3. Immediate pacemaker implantation
4. Bedside telemetry
5. Cardiac MRI

79. Question

Is prophylactic permanent pacemaker implantation indicated before TAVI in patients with right bundle branch block (RBBB) and no indication for permanent pacing?

1. Yes, it is always indicated.
2. It is only indicated in patients with severe symptoms.
3. It is indicated in patients with mild to moderate symptoms.
4. It is indicated in patients with any form of heart block.
5. No, it is not indicated before TAVI in these patients.*

80. Question

In patients with congenital complete or high degree AVB, pacing is recommended if one of the following risk factors is present. Which of the following is NOT a risk factor that warrants pacing?

1. Symptoms
2. Pauses >3x the cycle length of the ventricular escape rhythm
3. Broad QRS escape rhythm
4. Mean daytime heart rate >60 b.p.m. \*
5. Prolonged QT interval

81. Question

In patients with congenital complete or high degree AVB, what may be considered even if no risk factors are present?

1. Temporary pacing
2. Permanent pacing*
3. Medication therapy
4. Watchful waiting
5. Surgical correction

82. Question

In patients with persistent postoperative bifascicular block associated with transient complete AVB, what is the recommended intervention according to clinical practice guidelines for cardiac pacing in patients with congenital heart disease?

1. Temporary pacing
2. Permanent pacing may be considered*
3. No intervention needed
4. Immediate surgery
5. Monitor and wait

83. Question

In patients with complex congenital heart disease (CHD) and asymptomatic bradycardia (awake resting heart rate 3 s), what is the recommended course of action regarding permanent pacing?

1. Permanent pacing should be avoided.
2. Permanent pacing is mandatory for all patients.
3. Permanent pacing may be considered on an individual basis.*
4. Permanent pacing is only recommended for symptomatic patients.
5. Permanent pacing is not recommended under any circumstances.

84. Question

In patients with hypertrophic obstructive cardiomyopathy (HOCM) who are in sinus rhythm (SR) and have other pacing or ICD indications, under what conditions may AV sequential pacing with a short AV delay be considered?

1. When there are drug-refractory symptoms or baseline or provokable left ventricular outflow tract gradients 50 mmHg.*
2. When there are drug-refractory symptoms regardless of left ventricular outflow tract gradients.
3. Only when there are baseline left ventricular outflow tract gradients 50 mmHg.
4. When there are provokable left ventricular outflow tract gradients 30 mmHg.
5. Only in patients without other pacing or ICD indications.

85. Question

In which scenario may AV sequential pacing with a short AV delay be considered for hypertrophic obstructive cardiomyopathy?

1. In adults with mild symptoms who are open to invasive septal reduction therapies
2. In adults with drug-refractory symptoms, 50 mmHg baseline or provokable LV outflow tract gradient, in SR, unsuitable for or unwilling to consider other invasive septal reduction therapies*
3. In children with hypertrophic obstructive cardiomyopathy and no significant symptoms
4. In adults with drug-refractory symptoms but with less than 50 mmHg LV outflow tract gradient
5. In adults with hypertrophic obstructive cardiomyopathy who are already on effective medication therapy

86. Question

In patients with hypertrophic obstructive cardiomyopathy who have drug-refractory symptoms, baseline or provocable LV outflow tract gradients of 50 mmHg, are in sinus rhythm (SR), and are at high risk of developing AV block during septal ablation, what pacing strategy may be considered?

1. Dual chamber pacing with long AV delay
2. AV sequential pacing with short AV delay*
3. Single chamber ventricular pacing
4. Biventricular pacing
5. Single chamber atrial pacing

87. Question

In patients with neuromuscular diseases such as myotonic dystrophy type 1 and any second- or third-degree AVB or HV 70 ms, with or without symptoms, what is indicated?

1. Temporary pacing
2. Medication management
3. Lifestyle modifications
4. Permanent pacing*
5. Surgical intervention

88. Question

In patients with neuromuscular disease such as myotonic dystrophy type 1, which of the following conditions may warrant consideration for permanent pacemaker implantation?

1. PR interval <200 ms
2. QRS duration <100 ms
3. PR interval 240 ms*
4. QRS duration <120 ms
5. PR interval between 200-230 ms

89. Question

In patients with LMNA gene mutations, including Emery Dreifuss and limb girdle muscular dystrophies, who fulfill conventional criteria for pacemaker implantation or who have prolonged PR interval with LBBB, what should be considered if at least 1 year survival is expected?

1. Pacemaker implantation without ICD capabilities
2. Immediate heart transplant
3. ICD implantation with pacing capabilities*
4. Use of antiarrhythmic medication only
5. Cardiac resynchronization therapy (CRT) without ICD

90. Question

In patients with Kearns-Sayre syndrome who have PR prolongation, any degree of AVB, BBB, or fascicular block, what should be considered?

1. Temporary pacing
2. Permanent pacing*
3. No intervention
4. Intermittent monitoring
5. Medication therapy

91. Question

In patients with Kearns-Sayre syndrome without cardiac conduction disorder, what intervention may be considered prophylactically?

1. Temporary pacing
2. Permanent pacing*
3. Defibrillator implantation
4. Medication therapy
5. Lifestyle modification

92. Question

In patients with cardiac sarcoidosis who have permanent or transient AVB, what intervention should be considered according to the guideline recommendations?

1. Medication adjustment
2. Lifestyle changes
3. Surgical ablation
4. Implantation of a device capable of cardiac pacing*
5. Regular monitoring without intervention

93. Question

In patients with sarcoidosis and an indication for permanent pacing who have LVEF <50%, what type of device implantation should be considered?

1. AICD
2. Single-chamber pacemaker
3. Dual-chamber pacemaker
4. CRT-D*
5. Loop recorder

94. Question

What is recommended to reduce the risk of CIED infection in the perioperative management of device implantations?

1. Administration of preoperative antibiotic prophylaxis within 2 hours of skin incision
2. Administration of preoperative antibiotic prophylaxis within 1 hour of skin incision*
3. Administration of preoperative antibiotic prophylaxis within 30 minutes of skin incision
4. Administration of postoperative antibiotic prophylaxis within 1 hour of skin incision
5. Administration of postoperative antibiotic prophylaxis within 2 hours of skin incision

95. Question

Which antiseptic solution is recommended for skin antisepsis in device implantations and perioperative management?

1. Povidone-iodine alcohol
2. Chlorhexidine alcohol*
3. Isopropyl alcohol
4. Hydrogen peroxide
5. Ethanol

96. Question

For venous access in device implantations and perioperative management, which vein should be considered as the first choice?

1. Jugular vein
2. Femoral vein
3. Subclavian vein
4. Cephalic vein*
5. Radial vein

97. Question

To confirm target ventricular lead position, what should be considered?

1. Use of a single fluoroscopic view
2. Use of multiple fluoroscopic views*
3. Use of echocardiography
4. Use of MRI
5. Use of CT scan

98. Question

For implantation of coronary sinus leads, which type of lead should be considered as the first choice?

1. Bipolar leads
2. Unipolar leads
3. Quadripolar leads*
4. Tripolar leads
5. Hexapolar leads

99. Question

Regarding device implantations and perioperative management, which of the following should be considered before wound closure?

1. Rinsing the device pocket with normal saline solution*
2. Applying antibiotic ointment to the device pocket
3. Using povidone-iodine solution to rinse the device pocket
4. Leaving the device pocket dry before closure
5. Rinsing the device pocket with sterile water

100. Question

In patients undergoing a reintervention CIED procedure, what may be considered to reduce the risk of infection?

1. Increased dosage of anticoagulants
2. Use of an antibiotic-eluting envelope*
3. Prolonged fasting before the procedure
4. Administration of high-dose steroids
5. Use of a different type of pacemaker

101. Question

In patients at high risk of perforation, which pacing site may be considered?

1. Right atrial appendage
2. Left ventricular apex
3. Right ventricular apex
4. Mid-ventricular septum*
5. Left atrial appendage

102. Question

In patients with possible pocket issues such as increased risk of erosion due to low body mass index, Twiddlers syndrome, or for aesthetic reasons, what type of device pocket may be considered for pacemaker implantations?

1. Subcutaneous device pocket
2. Submuscular device pocket*
3. Epicardial device pocket
4. Endocardial device pocket
5. Intravenous device pocket

103. Question

In the context of device implantations and perioperative management, what is recommended regarding heparin-bridging for anticoagulated patients?

1. Heparin-bridging of anticoagulated patients is recommended.
2. Heparin-bridging of anticoagulated patients is optional.
3. Heparin-bridging of anticoagulated patients is required before surgery.
4. Heparin-bridging of anticoagulated patients is not recommended.*
5. Heparin-bridging of anticoagulated patients is recommended only in high-risk cases.

104. Question

According to clinical practice guidelines, under what condition should permanent pacemaker implantation be delayed?

1. When the patient has a history of hypertension
2. When the patient has a history of diabetes
3. When the patient has a history of arrhythmia
4. When the patient has fever*
5. When the patient has a low heart rate

105. Question

In patients with MRI-conditional pacemaker systems, MRIs can be performed safely under what condition?

1. Without any restrictions
2. Following the manufacturer's instructions*
3. Only in emergency situations
4. With prior approval from a cardiologist
5. After a waiting period of 6 months

106. Question

In patients with non-MRI-conditional pacemaker systems, under what conditions should MRI be considered?

1. If there are abandoned or damaged leads present
2. If there are epicardial leads present
3. If no alternative imaging mode is available and no epicardial leads, abandoned or damaged leads, or lead adaptors/extenders are present*
4. If lead adaptors or extenders are present
5. If the patient has MRI-conditional pacemaker systems

107. Question

Under what condition may MRI be considered in pacemaker patients with abandoned transvenous leads?

1. If the patient has a history of myocardial infarction
2. If no alternative imaging modality is available*
3. If the patient is experiencing acute chest pain
4. If the patient has a new pacemaker implanted
5. If the patient has a known allergy to contrast agents

108. Question

In cases of hemodynamic-compromising bradyarrhythmia refractory to intravenous chronotropic drugs, what is recommended?

1. Permanent pacemaker implantation
2. Temporary transvenous pacing*
3. Oral chronotropic medication
4. Electrical cardioversion
5. Defibrillation

109. Question

In cases of hemodynamically compromising bradyarrhythmia, what should be considered when temporary transvenous pacing is not possible or available?

1. Permanent pacemaker implantation
2. Pharmacological intervention
3. Transcutaneous pacing*
4. Watchful waiting
5. Electrical cardioversion

110. Question

When should temporary transvenous pacing be considered according to the clinical practice guidelines?

1. In patients with chronic atrial fibrillation
2. When pacing indications are expected to be reversible, such as in myocardial ischemia, myocarditis, electrolyte disturbances, toxic exposure, or after cardiac surgery*
3. For patients with stable angina
4. In cases of chronic heart failure
5. For patients with permanent pacemaker infections

111. Question

In which scenario should temporary transvenous pacing be considered as a bridge to permanent pacemaker implantation?

1. When the permanent pacemaker implantation is immediately available.
2. When the patient has no concomitant infection.
3. When the permanent pacemaker implantation is not immediately available or possible due to concomitant infection.*
4. When the patient has a stable heart rhythm.
5. When there are no contraindications to immediate permanent pacemaker implantation.

112. Question

What type of lead should be considered for long-term temporary transvenous pacing?

1. Passive fixation lead inserted through the skin and connected to an external pacemaker
2. Active fixation lead inserted through the skin and connected to an external pacemaker*
3. Bipolar lead inserted through the skin and connected to an external pacemaker
4. Unipolar lead inserted through the skin and connected to an external pacemaker
5. Dual-chamber lead inserted through the skin and connected to an external pacemaker

113. Question

In the context of managing a patient for whom pacing is no longer indicated, what should the management strategy be based on?

1. The physician's personal experience and preference.
2. A standardized protocol that applies to all patients.
3. An individual risk-benefit analysis in a shared decision-making process together with the patient.*
4. The most recent technological advancements available.
5. The patient's family history and genetic predisposition.

114. Question

According to the guidelines, what is recommended for patients with pacemakers who have difficulties attending in-office visits?

1. Increased frequency of in-office follow-ups
2. Remote device management to reduce the number of in-office follow-ups*
3. No follow-up is necessary
4. Only emergency in-office visits
5. Regular home visits by a healthcare professional

115. Question

What is recommended for patients with a recalled or advisory device component, particularly those at increased risk, such as in case of pacemaker-dependency?

1. Regular in-person follow-up visits
2. Increased physical activity monitoring
3. Remote monitoring*
4. Dietary modifications
5. Medication adjustments

116. Question

In-office routine follow-up of single- and dual-chamber pacemakers may be spaced by up to how many months in patients on remote device management?

1. 12 months
2. 18 months
3. 24 months*
4. 30 months
5. 36 months

117. Question

Which of the following is recommended to be considered for the earlier detection of clinical problems or technical issues in pacemaker management?

1. In-person follow-up visits
2. Remote device management of pacemakers*
3. Annual check-ups
4. Monthly battery checks
5. Manual lead testing

118. Question

In patients considered for pacemaker or CRT, what factors should the decision be based on, and what approach is recommended during the consultation?

1. The physician's experience and the patient's financial status
2. The best available evidence, individual riskbenefits, patient preferences, goals of care, and an integrated care approach using principles of patient-centered care and shared decision-making*
3. Hospital protocols and availability of devices
4. The patient's family history and genetic predisposition
5. The latest technological advancements and the physicians preferences