A 68-year-old woman with chronic atrial fibrillation (AF) and a ventricular rate of 140 bpm presents with palpitations and fatigue. Her blood pressure is 110/70 mmHg. Cardiac examination reveals an irregularly irregular rhythm with a soft S1. Echocardiography shows normal left ventricular ejection fraction (LVEF 50%) and normal chamber dimensions. Which of the following factors is most significantly reducing her cardiac output in this clinical scenario?

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