A 58-year-old man is followed in the heart failure clinic for a 3 year history of symptomatic dilated cardiomyopathy:

• Sinus rhythm, 90/min.
• Biatrial enlargement
• Left ventricular hypertrophy with repolarization abnormality

A recent echocardiogram demonstrated dilated left ventricle and left atrium and moderate mitral and tricuspid regurgitation.