A patient with persistent atrial fibrillation has LVEF 35%, resting heart rate 138/min and worsening congestion despite diuresis. He is

Question

A patient with persistent atrial fibrillation has LVEF 35%, resting heart rate 138/min and worsening congestion despite diuresis. He is anticoagulated and has no pre-excitation. Which rate-control strategy is most appropriate initially?

Accepted Answer

Use digoxin then optimize beta blockade after decongestion

Answer

Start verapamil at full dose to rapidly lower heart rate

Answer

Use flecainide because reduced EF makes it more effective

Answer

Give adenosine repeatedly until sinus rhythm returns

Answer

Withhold all rate control until elective ablation is arranged

Perioperative medicine — RCPSC IM MCQ

A patient with persistent atrial fibrillation has LVEF 35%, resting heart rate 138/min and worsening congestion despite diuresis. He is anticoagulated and has no pre-excitation. Which rate-control strategy is most appropriate initially?