Which of the following conditions does not require the placement of a pacemaker?

Choice A rationale:

Bradycardia refers to a slow heart rate, typically defined as less than 60 beats per minute.

While some ICDs can provide pacing for bradycardia, this is not their primary purpose.

Their primary goal is to prevent sudden cardiac death from life-threatening arrhythmias.

Therefore, Choice A is not the best response.

Choice B rationale:

Atrial fibrillation (AFib) is a common heart rhythm disorder characterized by rapid and irregular beating of the atria.

While ICDs can sometimes be used in patients with AFib, this is not their primary indication.

AFib is typically managed with medications to control heart rate and rhythm, or with ablation procedures to disrupt the abnormal electrical pathways.

Therefore, Choice B is not the best response.

Choice C rationale:

Ventricular fibrillation (VF) and ventricular tachycardia (VT) are life-threatening arrhythmias that originate in the ventricles of the heart.

VF is characterized by chaotic, disorganized electrical activity in the ventricles, leading to ineffective pumping and cardiac arrest.

VT is a very fast heart rhythm that can degenerate into VF.

ICDs are specifically designed to detect and treat VF and VT.

They do this by delivering electrical shocks to the heart, which can restore a normal rhythm.

Therefore, Choice C is the best response.

Choice D rationale:

While ICDs can deliver shocks during a heart attack, this is not their primary purpose.

Heart attacks are caused by a blockage of blood flow to the heart muscle, and they are typically treated with medications, such as aspirin, nitroglycerin, and clot-busting drugs.

ICDs are primarily used to prevent sudden cardiac death from life-threatening arrhythmias, not to treat heart attacks themselves.

Choice A rationale:

Digoxin is a medication that slows the heart rate. It would be contraindicated in this patient because they are already bradycardic.

Administering digoxin could further slow the heart rate and worsen the patient's symptoms.

Additionally, digoxin can have a negative inotropic effect, which could further compromise the patient's hemodynamic status. Choice B rationale:

While it is important to continue to monitor the patient, this is not an intervention that will address the patient's bradycardia and hypotension.

The patient is already symptomatic, and their heart rate and blood pressure are likely to continue to decline without intervention. Choice C rationale:

Defibrillation is used to treat life-threatening arrhythmias such as ventricular fibrillation and pulseless ventricular tachycardia.

It is not indicated for sinus bradycardia.

Choice D rationale:

Transcutaneous pacing is a non-invasive method of pacing the heart.

It can be used to temporarily increase the heart rate in patients with symptomatic bradycardia.

This is the most appropriate intervention for this patient because it will address the underlying problem of bradycardia and improve the patient's hemodynamic status.