MRCP2-0245

MRCP2-0245

A 28-year-old male presents to the Emergency department with sudden onset palpitations at home. He has a history of a heart problem but is unsure of the details.

Upon arrival, his initial pulse rate is 200 irregularly irregular but intermittently reverts to sinus rhythm at 70 beats per minute. The cardiac monitor shows frequent paroxysms of tachycardia. His blood pressure is 110/70 mmHg.

A 12 lead ECG during tachycardia reveals an irregular rhythm with broad QRS complex, and in sinus rhythm, a short PR interval with a slurred upstroke to the QRS complex. The patient denies any chest pain or breathlessness.

What is the most appropriate next management step from the options below?