For a patient with frequent episodes of palpitations and diagnosed with paroxysmal atrial fibrillation, which long-term therapy is most appropriate?

In a patient with paroxysmal atrial fibrillation experiencing frequent palpitations, the primary goal of long-term therapy is to control the rate of the heart and prevent the recurrence of atrial fibrillation episodes. Diltiazem, a calcium channel blocker, is particularly effective at rate control in this scenario. Its use can help manage heart rate during episodes of atrial fibrillation and can also prevent the initiation of further episodes, which is critical for patient comfort and reducing symptoms.

Moreover, diltiazem has the advantage of being well-tolerated with a favorable side effect profile compared to other antiarrhythmic agents. It acts by slowing conduction through the AV node and reducing the heart rate, making it a suitable choice for rate control in patients with paroxysmal atrial fibrillation.

In contrast, while amiodarone is a potent antiarrhythmic that can be used for rhythm control and maintaining sinus rhythm, its long-term use is often associated with a greater risk of adverse effects and toxicity. Digoxin can be beneficial for rate control but is usually more effective in sedentary patients with heart failure or those who do not tolerate other rate-controlling medications. Metoprolol, a beta-blocker