If a patient with atrial fibrillation exhibits symptoms of dizziness along with a heart rate of 140 beats/minute and normal blood pressure, what should be the first-line treatment?

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In the management of atrial fibrillation, particularly in a patient who presents with symptoms such as dizziness and a rapid heart rate of 140 beats per minute but maintains normal blood pressure, intravenous diltiazem is an appropriate first-line choice. Diltiazem is a calcium channel blocker that effectively slows down the conduction through the atrioventricular (AV) node, thereby helping to control ventricular rate in patients with atrial fibrillation. This can alleviate symptoms associated with rapid heart rates, such as dizziness.

The use of diltiazem is well-supported in cases of rapid ventricular response due to atrial fibrillation or atrial flutter. Its intravenous formulation provides rapid onset of action, which is particularly beneficial in symptomatic patients. Moreover, its efficacy in reducing heart rate while maintaining hemodynamic stability makes it an ideal initial treatment.

In contrast, while other options like intravenous amiodarone can also be effective in rate control, it is typically reserved for cases where other treatments are ineffective or when there are concerns about the patient's hemodynamic stability. Immediate direct current cardioversion (DCC) is generally indicated for patients with significant hemodynamic instability or severe symptoms not responsive to medical therapy. IV digoxin may be considered, especially

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