Abstract
A 77-year-old woman with a history of hypertension treated with metoprolol presents for her annual examination. She reports no new symptoms. The examination is remarkable only for an irregular heart rate. Electrocardiographic testing reveals atrial fibrillation at an average rate of 75 beats per minute. She has no history of arrhythmia, coronary disease, valvular disease, diabetes, alcohol abuse, or transient ischemic attack or stroke. What should her physician advise?