A 75-year-old man with a history of hypertension for many years, is seen in the emergency room complaining of malaise and lightheadedness. His only medication is lisinopril 20 mg daily. On physical examination, his blood pressure is 158/92 mm Hg. His lungs are clear and cardiac examination is benign. His ECG is shown. His dobutamine echocardiogram performed 2 months ago prior to knee replacement surgery was negative for ischemia and demonstrated a normal left ventricular ejection fraction.

Which of the following is the most appropriate next step in his management?

1. EP study to determine if 2:1 block is above or below the His bundle.
2. Outpatient event looping arrhythmia event monitoring.
3. Outpatient 48-hour Holter monitoring.
4. Implantation of a dual-chamber permanent pacemaker.