If your echo is normal than your fine stop worrying.thats such a low burden.
The ventricular couplet after a pac is interesting. What is your age? Of over 50 its not so abnormal, but under is a bit more significant even as an isolated incident.
Did you exercise while wearing the holter? Did you perform a stress test? These results are useful.
I would start a low dose metoprolol regimen and retake a holter and stress. Echo results matter as well.
Couplets are a matter of signidicant debate, Ive read alot of different opinions on management. There is some evidence that while the couplet itsself is not dangerous, it could be a red flag that identifies patients that are higher risk.
Increase in the freauency of couplets over the years is an even stronger predictor, as is a marked increase in couplets in exercise or recovery.
While it is true that a singular couplet is not necessarily dangerous, it IS likely reentrant in nature. Imo it oays ti be cautious here. Requests metoprolol and a stress.