One Saturday afternoon, my husband told me

One Saturday afternoon, my husband told me he was not feeling well and hadn’t for the last hour or so. I did a quick assessment and as part of the assessment I felt his pulse. I was not happy when I realized that he was in AFib. We live very close to the Mayo Hospital in Phoenix, and I took him to the ED. A diltiazem drip was started to give him a chance to convert to NSR before undergoing electrical cardioversion. An hour before he was to undergo electrical cardioversion, he converted to NSR. In the past decade, my husband has only been in AFib twice, so has paroxysmal AFib, but both times required a trip to the ED. His CHADS score is two – due to his age only. If he were your patient, what medications would you start and why? Since he has only had two episodes of AFib in ten years, would you risk the possible adverse effects of anticoagulation?

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