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At 45 years of age, the patient had atrial fibrillation at an average ventricular rate of approximately 55 beats per minute. The results of physician examination, echocardiography, tests of thyroid function, and measurements of electrolytes were normal. After 24 hours of observation, external electrical cardioversion was attempted at progressive energy levels up to 400 J, without success. The patient was discharged home with instructions to take aspirin.
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