Hemodynamically Unstable Wide Complex Tachycardia in a Young Woman

A 31-year-old woman was brought to the emergency room following an episode of near syncope preceded by palpitations. She was noted to have a wide-complex tachycardia (Figure 1), and was emergently cardioverted. The electrophysiology service was consulted for further management.

Figure 1

Top Image: ECG rhythm strips

Figure 1: ECG rhythm strips (top) 2 D-Echo - Structurally normal heart with preserved EF (bottom)

Bottom Image: 2 D-Echo - Structurally normal heart with preserved EF.

Past medical history includes severe obesity (body mass index of 50 kg/m2), obstructive sleep apnea, and well-controlled hypertension and type II diabetes mellitus.

Lisinopril 10 mg once daily, Gemfibrozil 600 mg twice daily and Metformin 1000 mg twice daily.

Physical Exam:
Vital signs: Afebrile, HR 75/min, BP 126/65 mm Hg, RR 14/min

General-Alert, in no acute distress
Neck- No jugular venous distension
Extremities-no edema, normal pulses

Laboratory Values: (provide ranges)

Based on the clinical presentation, what is the next best step in this patient’s management?

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