I'm an athletic otherwise healthy 63 yo female with around 30-40,000 PVCs/day- prob lifelong at decreased frequency- that were asymptomatic until July when pre-syncope & syncope began upon recovery from exercise, which progressed to shortness of breath, tachycardia, & occasional chest pain. After 2 ep studies w RVOT RF ablation then LVOT venous cryoablation, it was determined that I have an ectopic epicardial focus sitting right on the LAD off an oblique terminal cardiac vein (mapped with the rf probe) that is too big for the cryo probe & too dangerous to ablate with heat. They also found sinus node dysfunction & an ectopic atrial focus (the suspected source of tachycardia.) No VT was induced. High dose flecainide with diltiazem is effective but the flecainide causes visual symptoms, dizziness & fatigue that render me nonfunctional. Mexiletine w dilt is ineffective, metoprolol doesn't work w my bradycardia, & now they are increasing the rythmol & continuing cardizem but I'm still in bigeminy & highly symptomatic when my pulse gets down on the 20's & 30's from the pvcs. Stress echo shows great exercise tolerance & other than mild asymmetric lvh (no hypertension history) & ST depression of 2mm (told that's nl in women) & frequent recovery pvcs is pretty normal. EKG is pretty normal except for lvh by voltage criteria & the pvcs & nonspecific st-t changes. Can anyone think of anything else to try? I am not an anxious person nor do I have any drugs or alcohol to quit. The only time I feel okay is when my sympathetic nervous system gets stimulated- exercise, emotion, etc. but when that wears off, I get unable to drive or walk around as my brain does not seem to get enough oxygen with the low heart rate from pvcs. Any thoughts much appreciated!