A 54-year-old male with palpitations and atrial fibrillation shows a heart rate of 130-150. What is the key management step?

In the context of a patient experiencing atrial fibrillation with a rapid heart rate of 130-150 beats per minute, the primary management focus is on controlling the ventricular rate. Pharmacologic ventricular rate control is essential to stabilize the heart's rhythm and alleviate symptoms such as palpitations, which can result from the fast heart rate. Medications such as beta-blockers, calcium channel blockers, or digoxin can effectively reduce heart rate and improve the patient’s condition.

While anticoagulation is crucial in long-term management of atrial fibrillation to prevent thromboembolic events, it does not address the immediate need for rate control. Cardioversion may be considered if the patient is stable and there is a desire to restore normal sinus rhythm quickly, but it is not the first step when rapid ventricular rate is present in an acute setting. Radiofrequency ablation is a more invasive procedure typically reserved for patients with persistent atrial fibrillation or those who have failed multiple medical therapies. Therefore, focusing on pharmacologic control is the most appropriate step in this scenario.