Which next step is appropriate for the management of a patient with atrial fibrillation and irregularly irregular peripheral pulses?

In the management of a patient with atrial fibrillation characterized by irregularly irregular peripheral pulses, the use of anticoagulation therapy such as heparin and warfarin is appropriate. Atrial fibrillation increases the risk of thromboembolic events, particularly stroke, due to the potential for blood clots forming in the left atrial appendage.

Anticoagulation is crucial in this scenario to reduce the risk of these complications. Heparin provides immediate anticoagulation, while warfarin, a vitamin K antagonist, is used for long-term management. The combination allows for rapid initiation of anticoagulation while transitioning to longer-term therapy.

Other interventions, such as catheterization, defibrillation, or electrical conversion, are not immediately indicated in this context as they are geared more towards rhythm control in hemodynamically unstable patients or those with other specific indications. In this case, the primary goal is the prevention of thromboembolic complications through proper anticoagulation management.