What is the most important management intervention for a patient with atrial fibrillation and a heart rate of 130-150?

Managing a patient with atrial fibrillation (AF) and a rapid heart rate, particularly in the range of 130-150 beats per minute, requires a focus on controlling the ventricular rate. Pharmacologic ventricular rate control is essential because it helps to stabilize the heart's rhythm and reduce symptoms associated with a high heart rate. In AF, the atria are beating irregularly, which can lead to an inefficient heartbeat and symptoms like palpitations, shortness of breath, and fatigue.

By implementing pharmacologic agents such as beta-blockers or calcium channel blockers, clinicians can effectively lower the ventricular rate, improving hemodynamics and enhancing the patient’s comfort. This rate control is particularly crucial in symptomatic patients or those who may have comorbid conditions exacerbated by a rapid heart rate.

While anticoagulation is an important aspect of AF management due to the risk of thromboembolism, the immediate concern in this scenario is to mitigate the rapid heart rate. Cardioversion may be necessary but is not the first step in every patient, especially if they are hemodynamically stable. Radiofrequency ablation is a more invasive intervention typically reserved for patients with recurrent AF or those who do not respond to medical management. Therefore, the immediate focus