MRCP2-0063

MRCP2-0063

A 54-year-old female presents to the cardiology clinic with increasing shortness of breath. She has a history of dilated cardiomyopathy and received a CRT implant six months ago. Additionally, she has atrial fibrillation and is currently taking bisoprolol 10 mg, ramipril 10 mg, spironolactone 25 mg, furosemide 40 mg, warfarin, and digoxin 250 mcg. Her echocardiogram reveals an ejection fraction of 33%. On examination, her heart rate is 78 bpm, and her ECG shows a left bundle branch block (LBBB) with a QRS of 130 ms and atrial fibrillation. Her device interrogation indicates that she is paced 92% of the time.

What would be the next step in managing this patient?