RT Book, Section
A1 Harvey, Robert D.
A1 Grant, Augustus O.
A2 Katzung, Bertram G.
A2 Vanderah, Todd W.
SR Print(0)
ID 1176970585
T1 Agents Used in Cardiac Arrhythmias
T2 Basic & Clinical Pharmacology, 15e
YR 2021
FD 2021
PB McGraw-Hill
PP New York, NY
SN 9781260452310
LK accessmedicine.mhmedical.com/content.aspx?aid=1176970585
RD 2024/04/20
AB CASE  STUDYA  69-year-old  retired  teacher  presents  with  a  1-month  history  of  palpitations,  intermittent  shortness  of  breath,  and  fatigue*.  She  has  a  history  of  hypertension.  An  electrocardiogram  (ECG)  shows  atrial  fibrillation  with  a  ventricular  response  of  122  beats/min  (bpm)  and  signs  of  left  ventricular  hypertrophy.  She  is  anticoagulated  with  rivaroxaban  and  started  on  sustained-release  metoprolol,  50  mg/d.  After  7  days,  her  rhythm  reverts  to  normal  sinus  rhythm  spontaneously.  However,  over  the  ensuing  month,  she  continues  to  have  intermittent  palpitations  and  fatigue.  Continuous  ECG  recording  over  a  48-hour  period  documents  paroxysms  of  atrial  fibrillation  with  heart  rates  of  88–114  bpm.  An  echocardiogram  shows  a  left  ventricular  ejection  fraction  of  38%  (normal  ≥60%)  with  no  localized  wall  motion  abnormality.  At  this  stage,  would  you  initiate  treatment  with  an  antiarrhythmic  drug  to  maintain  normal  sinus  rhythm,  and  if  so,  what  drug  would  you  choose?