A 67-year-old woman with no significant past medical history presents to the emergency department with dyspnea. Her electrocardiogram shows atrial flutter with a ventricular rate of 150 beats/minute. Which of the following would be most effective for pharmacologic cardioversion to sinus rhythm in this patient?

Atrial flutter is a right-sided atrial re-entrant dysrhythmia characterized by a regular, rapid atrial rate of 240 to 400 beats/minute and an atrioventricular nodal block, which may range from 2:1 to 8:1. In patients who are hemodynamically unstable, synchronized cardioversion at 25 to 50 J is very effective at converting atrial flutter to sinus rhythm.

Amiodarone, a class III antidysrhythmic agent, is effective at converting atrial flutter to sinus rhythm as well as maintaining sinus rhythm and rate control.

Metoprolol is a β-receptor antagonist that controls ventricular rate but does not cardiovert atrial flutter...

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