help me figure this out

31 YOM here...
I have had SVT since my childhood. Early this year I did SVT ablations. The next day I was rushed to the hospital in VT. I think for a month or two before the ablation I had runs of VT (I felt my BP dropping/dizziness suddenly when the VT/palps would start).
My HR would go up into the high 200's when in VT, and continue on and of (at least 30-40 times a day) and they would run at least 20-30 beats each time.
My echo showed an enlarged right ventricle although the next day when the hospital did an MRI all was normal.
EP study couldn't induce VT.
I was sent home with orders to take 50mg of Toprol twice a day.

The VT seems to be triggering while under a lot of stress related to my work. I cut back on the stress and the VT seems to be gone for a couple of months now (except for the occational PVC or short runs of 2-3 beats of VT).

I followed up with another EP Dr. he did another EP study and was not induce able. He said that since they don't know the underlying disease is and I don't tolerate the toprol well, he recommends that I have an ICD implanted. He also said that even once the ICD is done he would suggest that I stay away from stress.
Just wondering what your thoughts are: some Dr.'s say that if the VT isn't induce able then there is absolutely nothing to be concerned about. While others say I'm in grave danger of going into cardiac arrest.
Should I put the ICD in?
Should I stay away from the trigger “stress”.
Can you recommend other beta blockers (toprol is depressing)

[Michael J. McWilliams, M.D.]

It is more difficult to recommend no therapy than to recommend therapy.  Putting in an ICD is easy but it is difficult to say if it is the right thing to do.  If you truly have a structurally normal heart and VT, you should not need an ICD.  The difficult question is do you have a structurally normal heart.

Where to live -- you need to go to a major medical center to have this question answered.  I can steer you toward an expert if I know where you live.

There are many different beta blockers that can be tried -- atenolol, carvedilol, nadolol.  In some cases, calcium channel blockers help as well.

You should try to avoid stress if it triggers your VT, but we both know this is easier said than done.  Some people notice their VT around the time of their menstrual cycle as well.

I hope this answers your question.

[cryrmrdrzs]

I live in NYC.

[Michael J. McWilliams, M.D.]

I emailed a friend at Sinai in NYC.  He uses an EP there named Avi Fischer.  He recommends him.  It might be worth asking him for a second opinion before having a device implant.

Good luck.