MCQ 25

A 67-year-old woman with a past medical history of paroxysmal atrial fibrillation for the last 10 years is brought to the hospital with episodes of syncope. Her medications include metoprolol, flecainide, and rivaroxaban. Baseline electrocardiogram showing sinus bradycardia with heart rate 40/min. Which of the following is the next best step in the management of this patient?
A. Hold metoprolol and flecainide
B. Permanent pacemaker placement
C. Observation only
D. Switch flecainide to dofetilide
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