What drug is most likely to restore sinus rhythm in a patient with atrial fibrillation and a ventricular rate of 130 beats/min?

Restoration of sinus rhythm in a patient with atrial fibrillation, especially when the ventricular rate is elevated, can be achieved through various pharmacological interventions. Adenosine is particularly effective in treating certain types of tachyarrhythmias, including paroxysmal supraventricular tachycardia, and can temporarily interrupt conduction through the AV node. This property can, in some cases, lead to conversion to sinus rhythm.

In the context of atrial fibrillation with a rapid ventricular response, adenosine may not be the conventional choice for pharmacological cardioversion. However, it can be used to assess if the rhythm is truly atrial fibrillation or if there is an underlying reentrant tachycardia that can be interrupted. While not primarily used to restore sinus rhythm in atrial fibrillation, its mechanism can sometimes promote a return to sinus rhythm by transiently slowing the rapid rate and allowing for the heart to reset.

The other medications listed, such as flecainide, are more commonly used for rhythm control; however, they typically need to be administered over a longer period or in specific scenarios. Bisoprolol and esmolol, both beta-blockers, are useful in rate control of atrial fibr