6th May 2025

A 69-year-old lady presents with worsening shortness of breath and orthopnoea at rest despite being on optimal medical management for heart failure.

A 69-year-old lady presents with worsening shortness of breath and orthopnoea at rest despite being on optimal medical management for heart failure. Her ECG shows normal sinus rhythm, pulse of 78 beats per minute and a QRS duration of 180ms. The most recent ECHO shows an LVEF of 20%. She has no history of arrhythmias. Which of the following can be considered as the next step in treatment?

Select the SINGLE most appropriate option from the list below. Select ONE option only.