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ModerateCardiovascularUnstable atrial fibrillationuk-plab-1

A 70-year-old man presents with sudden onset palpitations and breathlessness. He is hypotensive (BP 80/40 mmHg), tachycardic at 170 beats/min with an irregularly irregular rhythm, confused and clammy. ECG confirms atrial fibrillation. What is the most appropriate immediate management?

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