A 62-year-old man is seen in clinic with a 3-month history of palpitations and reduced exercise tolerance. He has hypertension treated with ramipril and was started on metoprolol by his family physician 6 weeks ago for a fast heart rate. His symptoms persist despite the metoprolol. He has no history of stroke, TIA, diabetes, or heart failure, and takes no other medications. An ECG shows an irregularly irregular narrow-complex rhythm with no P waves, and a symptom diary suggests the rhythm has been present continuously for more than 3 weeks. Creatinine, eGFR, TSH, and liver enzymes are normal. He is hemodynamically stable. Rhythm control has been chosen because he remains symptomatic.
| Heart rate | 96/min, irregularly irregular |
| Respiratory rate | 16/min |
| Temperature | 36.8 °C |
| O2 saturation | 98%, room air |
| Blood pressure | 128/78 mm Hg |
Question 1 of 36
Which one of the following is the most appropriate management at this time?
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