A patient with palpitations and stable vital signs has a rhythm on ECG that is causing concern but is not immediately life-threatening. What is the recommended initial management?

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When a patient is stable but has a tachycardia that raises concern, the best first move is a vagal maneuver. These maneuvers boost parasympathetic tone, slow conduction through the AV node, and can interrupt AV-node–dependent reentrant tachycardias like many cases of SVT. They’re quick, noninvasive, and can sometimes terminate the rhythm without medication. If the rhythm persists after a vagal maneuver, the next step is usually a pharmacologic attempt with adenosine, which temporarily blocks AV nodal conduction to reveal or terminate the arrhythmia. Defibrillation is reserved for unstable or pulseless situations, and amiodarone is typically used for other tachyarrhythmias such as wide-complex tachycardias or refractory cases, not as the initial management for a stable narrow-complex tachycardia.