A 65-Year-Old Man Comes to the Emergency Department Because of a 2-Hour

A 65-year-old man comes to the emergency department because of a 2-hour history of palpitations and lightheadedness. He has no chest pain or dyspnea. He has had 3 episodes of symptomatic atrial fibrillation that self-terminated within last week. He has hypertension treated with lisinopril. He is 183 cm (6 ft 0 in) tall and weighs 100 kg (220 lb) ; BMI is 30 kg/m2. Temperature is 37.0°C (98.6°F) , pulse is 150/min, and blood pressure is 130/85 mm Hg. Cardiac examination demonstrates tachycardia with irregularly irregular heartbeats.  ECG confirms atrial fibrillation.  The patient's ventricular rate is controlled with beta blocker therapy, but the arrhythmia fails to resolve as in previous episodes.  Which of the following factors is most likely involved in the progression of this patient's arrhythmia?

A) Abnormal atrioventricular nodal pathway
B) Atrial structural remodeling
C) Cardiac autonomic neuropathy
D) Conduction system fibrosis
E) Enhanced sinoatrial node automaticity

Correct Answer:

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