A 54-year-old man 3 weeks post NSTEMI presents to the Emergency ward with a history of palpitations and presyncope. The examination is unremarkable apart from a displaced apex (6th intercostal space, mid-clavicular line). He is monitored and ECG done. The rhythm strip obtained within the first 24hrs of his admission is attached along with.

What does the rhythm indicate? What would your initial management be? *This case is from Docplexus Editorial Team and is meant for educative purpose only.