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A 62-year-old man is brought to the emergency department after complaining of feeling lightheaded and dizzy as well as having chest palpitations. He denies any sense of pain or chest tightness, and does not feel sweaty or short of breath, although he has had myocardial infarctions in the past. However, he does note that he has had a bad œcold and productive, purulent cough for the last week. His pulse is 138/min and examination confirms an irregularly irregular rhythm. Right-sided crackles, egophony, and dullness to percussion are present on chest examination. A chest radiograph shows a corresponding infiltrate, and an electrocardiogram confirms the suspicion of atrial fibrillation. The patient is admitted with a diagnosis of pneumonia and atrial fibrillation and treated appropriately. Over the course of his hospital stay he receives diltiazem, metoprolol, and amiodarone for atrial fibrillation, in addition to empiric antibiotics for community-acquired pneumonia. His outpatient digoxin, used as part of his treatment regimen for congestive heart failure, is continued. Which of the following medications, if given, is most likely to convert his rhythm from atrial fibrillation to sinus rhythm?
A. Amiodarone
B. Digoxin
C. Diltiazem
D. Metoprolol
E. Sotalol

aaa

would'nt amiodarone be CI in this patient as he already has Lung manifestations?

The correct answer is A. This patient has underlying heart disease and with this episode of pneumonia went into atrial fibrillation. Amiodarone can chemically convert patients into a sinus rhythm, though it is not highly effective in this role. Its major role is in the maintenance of sinus rhythm once a patient has converted out of atrial fibrillation.

Digoxin (choice B), diltiazem (choice C), and metoprolol (choice D) are all agents used to treat atrial fibrillation. They work by controlling the rapid ventricular response to atrial fibrillation. They are no more successful than placebo for converting atrial fibrillation into a sinus rhythm. However, recently completed studies have shown no difference in mortality among rate-controlled versus rhythm-controlled patients.

Sotalol (choice E) is a class III antiarrhythmic drug. It has not been proven to chemically convert patients out of atrial fibrillation. It is used in a variety of situations to prevent recurrence of supraventricular tachycardias once sinus rhythm is restored