A 77-year-old man with hypertension but otherwise without known cardiac comorbidities presents to your clinic for routine follow-up. He is doing well and is asymptomatic, although he is undergoing evaluation by a neurologist for possible Parkinson’s disease. He relates that he has an upcoming hernia surgery. You perform an ECG for preoperative evaluation, shown in Figure 1:
Based on what you see here, what is the next step in the management of this patient (more than one answer may be correct)?
A. Start anticoagulation
B. Refer for direct current cardioversion
C. Refer for ablation
D. Delay surgery
E. No intervention needed; proceed with surgery