### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
hello, my name is Trent and i am a 34-year-old, slightly overweight (around 50lbs over BMI scale for my height) male police officer. for the last 2 years, ive been dealing with ventricular bigeminy/trigeminy as well as extremely frequent PVC s, tachycardia and the occassionally supraventricular tachycardia. at times the chest pains have been so bad i have passed out and hit the floor. i have not been able to work since january 2010. i have been hospitalized for these symptoms 6 times in the last year and half. i have been through 2 cardiac ablations and have been tried on metoprolol, soltalol, amiodarone, dronedarone, and 3 other antiarrythmics that i cannot remember the names of. neither ablation worked, and the second one caused more damage then good. prior to the second ablation (march 2011), my ejection fraction was 45% and there was mild diffuse hypokinesia in the left ventricle. after the second, ejection fraction dropped to 38% and there was moderate global hypokinesia of the left ventricular segments. structural disease was ruled out in 2010 by angiography and echocardiograms as well as a cardiac MRI. so far, none of the 5 cardiologists i have seen have been able to isolate the cause of all of my symptoms. my biological father had a pacemaker implanted at age 35 after he suffered an MI. i believe he was diagnosed with sick sinus syndrome. i have inquired into the possibilty of having SSS myself, but again, no one has confirmed or disproved this. since the failure of the ablations as well as the failure of antiarrythmics, the cardiologists that i have seen have told me there are no further treatment optins other then a 3rd ablation. having been through 2 already, i am definetly not eager to go for a 3rd. am i candidate for a pacemaker or ICD type device? and what is causing all of this? i shoud mention that cardiomyopathy was originally suspected, but again, not ruled out or confirmed. i was drinking alcohol on a regular basis up until november, and have not touched a drop since. any advice you could give me would greatly appreciated! i am extremely eager to have my condition treated and get back to work!! thank you for your time, trent a c wright.

### output:

Hello thanks for posting harbor seem to have refractory arrhythmias which despite medical and repeated ablations are not regressing. I think you must go ahead with a CRT -D implantation. I will resynchronize your heart contractions, and will correct your rhythm when required. It also has a back-up pacemaker activity which will pace the heart of rhythm is too low. It so gives you a small shock when the heart rate becomes irregular and life-threatening events can be avoided. You will only feel a small jerk during the episode. Sometime a notification will go to your cardiologist regarding the event so that he can get a tab on your health.Also, it is a very safe procedure and will not lead to decrease in your ejection fraction. Regards.