ECG of the Month: 82-Year-Old Woman with Controlled HTN Presents with Recurrent Orthostatic Lightheadedness without Syncope

An 82-year-old woman with controlled hypertension presents with recurrent orthostatic lightheadedness without syncope. Her blood pressure and heart rate are 110/70 mm Hg and 60 beats per minute (bpm) while sitting, and 85/65 mm Hg and 65 bpm while standing for five minutes, respectively. Her physical exam, including a comprehensive cardiac exam, was unremarkable. On echocardiography she had a normal left ventricular ejection fraction and no significant valvular disease. The following electrocardiograms (ECGs) were obtained within few minutes of each other (Figure 1).

Figure 1

Figure 1

Which of the following is the best next step?

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