What to do about 24/7 PACs since April 2009?

I am a 63 year old female with no heart disease confirned by echo cardiogram
and nuclear stress test, 4/09 .  I've never been aware of a single PAC in my entire life.  However, in April 2009, I was prescribed Kapidex for gastritis.Five weeks into the course in addition to other serious side effects, I developed strong chest pressure, intense irregular heart beats, and pernicious fatigue that forced me to bed for about 5 day.

I stopped the medication and saw a cardiologist who gave me the tests mentioned above.  I had a holter
monitor that showed 24/7 PACs with aprox. 127,000 beats during the day. I was prescribed
Cardizem but the medication made the chest pressure and arrythmia stronger.  I stopped it after
a few days and wasn't bothered with the PACs and chest pressure until I cleaned my deck in August.
The symptoms returned and it became clear that exertion also triggered the PAC's, etc.
  
Then I was given Bystolic with the same results.  Metropolol was the third medication
I tried but it made the symptoms worse and added approx 1,000 extra beats so the total
is now 128,000.  Since then I have three holter monitors showing the same results.

I have seen three cardiac electrophysioloigsts.  Two have dismissed by concerns about DVTs.  
(I had an unnecesarry cardio catherization in 2004 and developed a DVT.)  The third has acknoweldged
my concern and also told me that it is very likley the arrythmia is coming from the left atria.  He explained
that cardiac ablation of the left atrium is much riskier with a 1% rate of serious complications = 1 out of 100.
He prescribed 25 mg of Flecainide 2/x as a starting dose wiih out hospitilization.  I took 25 mg at 7 pm on 1/22/10 and woke up with a mild tacchycardia, a completely new symptom.

My questions are: 1) How likely will this condition become more serious (SVT's, A Fib)?  2) Given the risks
of the procedure and the side effects of medication, is better to learn to live with this condition?  3)  If
I have to have a cardiac ablation of the left atrium, who is the most experienced doctor you can recommend
to perform this procedure?  What is the success rate for my condition?  What  kind of recovery should I expect?
Will I need to take Heparin and coumadin for the possibility of both dvts and silent embolisms?

Thank you for your help.

[Jerry_NJ]

I can address only a few of your concerns, so I'll give you what I have and hope someone who has had an ablation for AFib will pitch in.  I suffer from AFib and because my symptoms are minor (to the doctor at least) they will not do an ablation, because of the risk you stated in your post.  If the symptoms are tolerable many just "live with it".  I take Metoprolol to control my HR, still about 90 at rest, and Warfarin and aspirin to protect against clots.  I am told studies show my life expectancy would not be improved if I had a successful ablation.  Still, I have seen periods of a year or more of normal sinus rhythm, and I like that a lot better than AFib.  I am currently in permanent AFib.

I have never been diagnosed with PVC, only AFib.  But, I think the number you have monitored is not considered extremely high, and I stand corrected if someone who knows better adds their knowledge.

Good luck,

[Allison456]

Thank you so much for your response.
I agree with what you wrote.  And,the more
research I've done, the more I think it's best
to live with the condition.  I still want to find out
and see  the best cardiac electrophysiologist for
ablation of the left atrium. This
way if things get really life threatening, I'll
have already become a patient of hi/her practice.

Good luck with your situation.  I hope things
continue to stay the same so you never need
an ablation.  ...some good news though... my 89
year old mother with heart problems and bad A Fib
had an ablation last year (right atria). It was very successful
and she is feeling so much better.

[chuparosa]

I had pvcs, then developed pacs, and then all of a sudden I started having tachycardia. This happened over many years. I recently got diagnosed with atrial flutter and I need a trans septal ablation (one foci in the pulmonary veins). My EP doctor told me that although there are risks involved with the procedure, a left atrial ablation is a fairly routine procedure. I guess my doc does quite a few of them especially for afib which he told me was a little bit more complicated because mostly he has to go round all the pulmonary veins not just the one as in my case. I do find the whole ablation thing very frightening, especially after having an ep study, but if I had the money (I'm in the process of saving), I'd surely have the ablation.