SVT or VT?

[sheshe00]

Background: During a run on Thanksgiving I ended up in tachycardia. Lucky for me an RN pulled over and took me to the ER. I was put on an EKG and my heart rate was at 260 wide complex tachycardia. The restarted my heart with Adenosine in an IV. I have had a cardiac MRI it has ruled out Hypertrophic Cardiomyopthy (I have a family history) and ARVD(the cardiologist thought I had ARVD based off my EKGs). The MRI showed no scar tissue and everything looks healthy. My cardiologist told me I had SVT and prescribed Flecanide. I have normal/low blood pressure. He told me the only way I would die is if I passed out in front of a bus. I then asked for an ablation. (My primary care DR told me to insist on one).

Turns out the cardiologist I saw was new and did not have operating privileges at the heart hospital. I saw a new cardiologist who said he did not think I had SVT based on my EKG from the emergency room. He said he had to assume VT and thinks I misunderstood my previous cardiologist (same practice). I did not misunderstand. I also found out from the new cardiologist that the cardiac MRI did show minor loss of functionality on my right side. I found out yesterday the halter monitor that I wore for three days prior to my cardiac MRI was never reviewed. I had always assumed it was normal. It had multiple episodes of tachycardia over a dozen. It also had two incidents of wide complex tachycardia at 200bpm and 231 bpm. The nurse said she was contacting her supervisor and my DR. I go in on 4 FEB for a EP. I was told that if it is SVT they will do an ablation, if it is VT they will do an ablation and a defibrillator, and if they cannot determine then I will get a defibrillator.  

I thought I was meeting the new cardiologist for a pre-op for just an ablation for SVT. I was totally thrown off guard. I dont know what to think I am back to having discussions about the priority being to keep me alive. How can I have VT with a healthy heart? How can I have SVT that is sustained at 230-260bpm?  I would like to know others opinions on if this sounds like SVT or VT. Everything I read says that if you have a healthy heart and VT then you do not need a defibrillator so why would my DR say I am getting one?  I have attached my EKG from the emergency room.

[tom_h]

Plenty of us have or have had sustained SVT at rates of 220 to 260.  As a 6 year old child, I had a rate of 312 bpm that was measured in a hospital. Mine would run on for hours...8f I allowed it to.   Sometimes, it can be difficult to determine VT vs. SVT with an aberrancy. Note, "With an aberrancy".  Do you have classic SVT, or are there some things in the waveform that could raise a question?  There a number of "algorithms" that can be used to determine the difference.
Look...I'm can only give you my feeling on this.  My feeling is that you're pushed along into this.  There is typically a "path" patients take that eventually may lead them into the electrophysiology lab.  You are NOT on this path.
Based on what you've said here, I'd have absolutely no confidence in the entire cardiology practice who have been seeing you!
After a lifetime, 54 years of SVT, I decided it was time to do something about it.  My cardiologist put me on a 30 day monitor which caught a couple of my 3 to 5 times a month events.  I was then put in contact with several electrophysiologists.  I wasn't assigned one, I CHOSE the electrophysiologist that felt I had confidence in, and one who made me feel.... right.  If it were me, I'd pull back a little bit, and rethink this.  For me, this is all going way to fast.  Cardiac ablation freed me from a lifetime of SVT.  I heartily recommend it.  But I would research and investigate further into what you experiencin before heading into the lab.  Just my opinion...