AFib With Pre-Excitation

Figure 1
Figure 1: AFib With Pre-Excitation
A 41-year-old male presented to the emergency department with palpitations. The heart rate was 255 beats/min and the blood pressure was 113/69. Synchronized cardioversion (100, 150 and 200 Joules) was attempted but was unsuccessful. After a loading dose of amiodarone, repeat cardioversion at 200 joules resulted in sinus rhythm; however, this was followed by an immediate recurrence of the tachycardia as shown in Figure 1.

What would you recommend for this patient?

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