What is the recommended initial treatment for a patient with stable atrial fibrillation and a rapid ventricular rate?

In a patient with stable atrial fibrillation and a rapid ventricular rate, the recommended initial treatment focuses on rate control to manage the heart rate effectively. Beta-blockers are the first-line pharmacological agents for achieving this goal, as they are effective in slowing conduction through the AV node and thereby reducing the ventricular response rate. The aim is to restore a more normal heart rhythm and alleviate symptoms that may arise from a rapid ventricular response.

Rate control is essential when the patient is stable and does not exhibit signs of hemodynamic instability. By employing beta-blockers, the treatment helps to improve symptoms and enhances the patient's overall tolerance to the arrhythmia without the immediate need for more aggressive measures.

Other options, while relevant in specific scenarios, do not serve as the initial treatment for stable patients with this condition. Anticoagulant therapy, for example, is important in preventing thromboembolic events but does not address immediate control of the heart rate. Immediate cardioversion is indicated for patients who are unstable or in situations where rapid restoration of sinus rhythm is crucial, while surgical intervention is not appropriate in the acute management setting for a stable patient.