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The first step to identifying a tachycardic heart rhythm is to determine if the QRS is wide or narrow. Narrow complex tachycardias typically originate above the ventricles while wide complex tachycardias typically originate in the ventricles and have a higher risk of deteriorating into cardiac arrest. For a patient with a regular narrow-complex stable tachycardia, it would be appropriate to attempt vagal maneuvers first. If that does not work then you should give adenosine 6 mg rapid IV push. If the patient does not convert and remains stable, give adenosine 12 mg rapid IV push. For a stable patient with an ECG rhythm that shows an irregular narrow-complex QRS tachycardia, it is probably atrial fibrillation, atrial flutter, or multi-focal atrial tachycardia. This would require expert consultation for treatment.