A 66-Year-Old Woman with Systolic Left Ventricular Dysfunction Comes to the Emergency

A 66-year-old woman with systolic left ventricular dysfunction comes to the emergency department due to dizziness, palpitations, and shortness of breath.  The symptoms started 2 days ago and have become progressively worse.  Her cardiologist prescribed an extra dose of oral furosemide yesterday, but her symptoms did not improve.  Six weeks ago, she was admitted for acute decompensated heart failure that was thought to be precipitated by atrial fibrillation.  The patient underwent electrical cardioversion and was diuresed with marked symptomatic improvement.  She has a history of atrial fibrillation, hypertension, type 2 diabetes mellitus, coronary artery disease, ischemic cardiomyopathy with a 30% ejection fraction, and osteoarthritis.  She underwent coronary artery bypass grafting 5 years ago.  Her current medications include low-dose aspirin, metoprolol, lisinopril, rosuvastatin, long-acting insulin, rivaroxaban, furosemide, and ibuprofen as needed.  The patient has been adherent to her medical regimen.  She does not use tobacco or alcohol.  Temperature is 36.7 C (98 F) , blood pressure is 126/82 mm Hg, pulse is 132/min and irregular, and respirations are 19/min.  Physical examination reveals bibasilar crackles on auscultation.  There are irregularly irregular heart sounds with no audible murmurs.  There is 1+ symmetric peripheral edema.  ECG shows atrial fibrillation with rapid ventricular response.  Serum creatinine level is 0.8 mg/dL.  After initial treatment, electrical cardioversion is planned.  Which of the following is the most appropriate medication for long-term management of this patient?

A) Amiodarone
B) Flecainide
C) Ranolazine
D) Valsartan
E) Verapamil