What is the most appropriate therapy for an unstable post CABG patient with atrial fibrillation?

In the scenario of an unstable post-coronary artery bypass grafting (CABG) patient experiencing atrial fibrillation, synchronized cardioversion is the most appropriate therapy. This is because atrial fibrillation can lead to inefficient ventricular filling and rapid rates, especially in the context of existing cardiovascular instability. When a patient is unstable, it is critical to restore a normal rhythm as quickly as possible to stabilize hemodynamics.

Synchronized cardioversion delivers a timed electrical shock that is synchronized to the patient's own heart rhythm. This allows for the shock to occur at a moment that is less likely to induce ventricular fibrillation, making it a safer and effective approach for treating unstable atrial fibrillation.

While medications like amiodarone can be used for rhythm control in stable patients, the urgency in this case, given the patient's instability, requires a more immediate intervention. Immediate defibrillation is appropriate for life-threatening arrhythmias like ventricular fibrillation or pulseless ventricular tachycardia but is not the first-line treatment for atrial fibrillation unless the patient is in a critical state. Adenosine is effective for certain types of supraventricular tachycardia but is not suitable for atrial fibrillation, especially when the