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Почему тогда блокада транзиторная?

Если нет преходящих состояний, в т. ч ОИМ, то обратимся к гайдлайну
http://circ.ahajournals.org/content/117/21/e350.full
а там - имплантация класс 1, уровень С...

Видимо эту часть...

Recommendations for Acquired Atrioventricular Block in Adults
Class I
1. Permanent pacemaker implantation is indicated for third-degree and advanced second-degree AV block at any anatomic level associated with bradycardia with symptoms (including heart failure) or ventricular arrhythmias presumed to be due to AV block. (Level of Evidence: C)^59,63,76,85
2. Permanent pacemaker implantation is indicated for third-degree and advanced second-degree AV block at any anatomic level associated with arrhythmias and other medical conditions that require drug therapy that results in symptomatic bradycardia. (Level of Evidence: C)^59,63,76,85
3. Permanent pacemaker implantation is indicated for third-degree and advanced second-degree AV block at any anatomic level in awake, symptom-free patients in sinus rhythm, with documented periods of asystole greater than or equal to 3.0 seconds86 or any escape rate less than 40 bpm, or with an escape rhythm that is below the AV node. (Level of Evidence: C)^53,58
4. Permanent pacemaker implantation is indicated for third-degree and advanced second-degree AV block at any anatomic level in awake, symptom-free patients with AF and bradycardia with 1 or more pauses of at least 5 seconds or longer. (Level of Evidence: C)
5. Permanent pacemaker implantation is indicated for third-degree and advanced second-degree AV block at any anatomic level after catheter ablation of the AV junction. (Level of Evidence: C)^87,88
6. Permanent pacemaker implantation is indicated for third-degree and advanced second-degree AV block at any anatomic level associated with postoperative AV block that is not expected to resolve after cardiac surgery. (Level of Evidence: C)^84,85,89,90
7. Permanent pacemaker implantation is indicated for third-degree and advanced second-degree AV block at any anatomic level associated with neuromuscular diseases with AV block, such as myotonic muscular dystrophy, Kearns-Sayre syndrome, Erb dystrophy (limb-girdle muscular dystrophy), and peroneal muscular atrophy, with or without symptoms. (Level of Evidence: B)^91–97
8. Permanent pacemaker implantation is indicated for second-degree AV block with associated symptomatic bradycardia regardless of type or site of block. (Level of Evidence: B)⁷⁴
9. Permanent pacemaker implantation is indicated for asymptomatic persistent third-degree AV block at any anatomic site with average awake ventricular rates of 40 bpm or faster if cardiomegaly or LV dysfunction is present or if the site of block is below the AV node. (Level of Evidence: B)^76,78
10. Permanent pacemaker implantation is indicated for second- or third-degree AV block during exercise in the absence of myocardial ischemia. (Level of Evidence: C)^81,82

Class III
3. Permanent pacemaker implantation is not indicated for AV block that is expected to resolve and is unlikely to recur¹⁰⁰ (e.g., drug toxicity, Lyme disease, or transient increases in vagal tone or during hypoxia in sleep apnea syndrome in the absence of symptoms). (Level of Evidence: B)^99,100

...Мы не можем знать когда она вернется в следующий раз...

В гайдах откуда взята картинка не дано определение, что такое постоянное и что такое временное...

В этой ситуации (что было непонятно, повторится ли неизвестно), конечно, синкопы - мощный аргумент для превентивной установки ПЭКС.

...Медицина не только лечит, но начинает уже предупреждать. Часто ли срабатывают ИКД после установки?

Лично виденный рекорд ИКД - 9 срабатываний за несколько часов..