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And, after the shock, if there is bradycardia, it can be covered by these two pacing electrodes, one at the tip, and one proximal to it. So, after myocardial infarction, the risk is more of heartfailure, than arrhythmic death. These are high voltage, defibrillator shock coils. That is one reason.
Use of drugs producing bradycardia like beta blockers in stages III and IV may precipitate low output state. One situation is decompensated advanced systolic heartfailure with large left ventricle. In stage IV, this restrictive filling pattern remains fixed even during Valsalva maneuver. Stage IV is considered as advanced.
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