Clinical circumstances will dictate whether a workup for venous thromboembolic disease or coronary artery disease should be undertaken. Digoxin takes the longest to slow the ventricular response. Digoxin will not lower the blood pressure which may or may not be beneficial depending on the patient's blood pressure. For chronic heart rate control, begin p.o. Check rate control during physical activity as well.
Digoxin tends to be the least effective at controlling the rate with physical activity.
None of these agents are terribly effective at converting the fibrillation back to sinus or preventing recurrent fibrillation in the future. Beta blockers are more likely to be effective in preventing reoccurrences than calcium blockers or digoxin. C. Consider IV Heparin followed by p.o. Coumadin, unless contraindicated. Target INR is 2.0 to 3.0.