A 68-year-old man with a history of hypertension and recent inferior wall myocardial infarction presents to the emergency department with syncope. His ECG shows a regular narrow-QRS rhythm with a rate of 45 bpm, absent P waves, and no evidence of AV block. The rhythm marked B in the diagram is identified as a junctional escape rhythm. Which of the following best explains why this patient is symptomatic despite a regular rhythm?

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