A 55-year-old man is presents with chest discomfo, fatigue, and palpitations. His blood pressure is 85/50 mm Hg and hea rate is 140 beats per minute. Which of the following is the best treatment for this patient?

Always cardiove any unstable patient (congestive hea failure), chest pain, hypotension) with atrial fibrillation. If the patient has atrial fibrillation and a rapid rate associated with severe hea failure or cardiogenic shock, emergency direct-current cardioversion is indicated. For patients with atrial fibrillation associated with rapid rate but with stable hemodynamics, attempts to achieve acute rate control are indicated. Drugs to slow the ventricular rate in patients with atrial fibrillation include digitalis preparations, calcium channel blockers (verapamil or diltiazem), and beta-blockers. If rapid rate control is desired, then calcium channel blockers and beta-blockers are far more effective than digitalis, which may require many hours before rate control is achieved. Ref: Scheinman M.M. (2009). Chapter 21. Atrial Fibrillation. In M.H. Crawford (Ed), CURRENT Diagnosis & Treatment: Cardiology, 3e.