This 80-year-old man was in very good health until 8 years ago, when he had episodes of near-syncope and documented ventricular tachycardia, that did not require cardioversion. He was hospitalized and no evidence of structural heart disease was found. He was placed on Amiodarone. He had no further episodes of VT. A few months ago the dose of Amiodarone was decreased to 100 mg per day and he was started on Metoprolol 25 mg twice daily. He remained moderately active with only mild dyspnea on climbing stairs. He is referred by his family physician for advice on his therapy:

• Sinus bradycardia with Mobitz I second degree AV block
• Left axis deviation
• Left anterior fascicular block
• Right bundle branch block
• Minor voltage criteria for left ventricular hypertrophy