A
60-year-old male is referred for management of paroxysmal atrial fibrillation.
These subjective episodes occur several times a week, lasting 1 to 6
hours and are associated with incapacitating palpitations and dizziness
. Multiple episodes of sinus rhythm and atrial fibrillation with ventricular
response of 100-130/min have been documented. There is history of an
extensive anterior and lateral wall myocardial infarction two years
ago. Echocardiography showed a left ventricular ejection fraction of
around 25% with expected segmental wall motion abnormalities. The patient
is on chronic anticoagulation with warfarin.
What is the antiarrhythmic agent of choice in this patient?
