VT vs SVT Dx

[Bromley]

I asked this question in a different way some time ago. After an ablation for left free wall WPW, I have experienced several incidences of narrow complex SVT, and a couple of incidences of an as yet "undiagnosed" wide complex rhytmn that could be either VT or SVT and which may have been given a "working diagnosis" of VT. In fact, the EP's exact words were that the wide complex "could be" SVT, so  I would imagine that obvious AV disassociation is not present. Also a subsequent heart cath did not show any signs of blockage, and no obvious signs of damage to arteries in the area of ablation (i.e. no blood flow issues, I assume underside the Mitral cusp). An echo was not revealing of any damage to my left outflow valve either.
I have said before to many people that if I had VT, it must have been caused by the ablation, because I never experienced the strong rapid arrythmia at rest (the paroxysm always started suddenly within first 15 minutes of strenuous aerobic activity), but now I have a lot of ectopy at rest, and short runs of either the narrow or wide complex at rest.
Without reversing the legitimacy of the working diagnosis for my situation, what is your opinion about the liklihood that two new arrythmias and new ectopy could be created by an RF ablation carried out correctly? One of the hypothesized arrthmias is a VT which has emerged in someone without any corornary artery disease and shows no AV disassociation, or other obvious indications that would clearly ID it as VT, although it could definitely be VT.
On the other side of this, is LVOT or another complication likely to arise after transaortic approach?
Please dont beat around the bush with this; I need to get past  medical/legal pitfalls so that I can correctly stratisfy my risk and decide whether I should go back for more.  Thanks in advance for any help.

[Michael J. McWilliams, M.D.]

I have not heard or read that successful SVT ablations cause other arrhythmias.  Atrial fibrillation ablations will sometimes cause atrial flutter, but this is not the cause for WPW.  WPW ablations usually are not very much tissue at al.  Equally I have not heard or read about the retro aoritic approach causing arrhythmias.

Unless the wide complex tachycardia was captured on a 12 lead EKG, it is unlikely to see AV dissociation on a Holter or 30 day monitor.

It is still possible that the wide complex tachycardia is still SVT.  An EP study should be able to tell you if it is SVT or not.

There are always theoretical chances that an ablation could cause another arrhythmia.  Proving that a second unrelated arrhythmia was caused by an ablation would be difficult to do conclusively.  I can understand your frustration but I do not think there is a yes or no answer -- that is probably why you are confused.

[Bromley]

Sorry #2. I also need to get passed my own ignorance before I will feel comfortable with this again, so I appreciate the help. :)

[Bromley]

Sorry. The SVT is also generally 10 beats or less, remarkably similar to the VT.

[Bromley]

One important additional fact. We are talking Monomorphic NSVT here (10 beats of less).