4th May 2025

A 20-year old man presents to ED with palpitations and presyncope.

A 20-year old man presents to ED with palpitations and presyncope. His ECG shows a broad complex tachycardia with an irregularly irregular rhythm with a ventricular rate of 170 bpm. From the end of the bed, he is looking pale and clammy. The nurses take a set of observations which are (HR 175, BP 70/50mmHg, RR 25, Temp 36.5).

Several years ago, he was told that he had an ‘abnormal’ conduction in heart which brought about his palpitations and was offered a procedure but declined this. He is otherwise well and takes no regular medications.

What is the next appropriate measure?

Select the SINGLE most appropriate option from the list below. Select ONE option only.