Wide Complex Tachycardia

Figure 3: Wide Complex Tachycardia

Figure 1: Wide Complex Tachycardia

Figure 2: Wide Complex Tachycardia

A 43-year-old previously healthy male, presents to cardiology clinic for episodes of dizziness and light-headedness while jogging. He was an avid runner for years, however, over the past few months, even with moderate jogging he gets light-headed and has to stop exercising. While he has not had a frank syncopal episode, he has become quite light-headed, with palpitations, and a "room spinning" sensation. His initial workup included an ECG with sinus bradycardia (Figure 1), and echocardiogram revealed a structurally normal heart with a normal ejection fraction. Baseline EKGExercise treadmill test revealed ventricular tachycardia 9 minutes into the Bruce Protocol at 9 mets. An MRI showed a structurally normal heart without evidence of scar tissue, hypertrophy, or other abnormalities. A coronary CT angiogram showed normal coronary arteries. He was placed on a beta-blocker, and was advised to avoid excessive caffeine and strenuous exercise. At the 6-month follow-up visit, he reported having symptoms sporadically despite his lifestyle modifications and titrating the beta-blocker to a resting heart rate in the 50s. His physician referred him again for an exercise treadmill test. After exercising for 13 minutes he became dizzy and had a run of non-sustained ventricular tachycardia (Figures 2 and 3). The treadmill test was aborted and his ventricular tachycardia spontaneously self terminated.

Based on the above information, the next most appropriate step would be:

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