instruction: hello doctor I am a 60 year old male who just received the results of a 24 hour hotter monitor key findings include sinus rhythm with frequent supraventricular ectopy 2559 which included couplets and one seven beat she multiplet no complex forms no significant pauses or periods of heart block noted constant feeling of missed beats coincides with frequent supraventricular ectopy very infrequent ventricular ectopy that was isolated and univocal cardiologists not concerned with findings and recommended positive affirmation distraction and cognitive behavioral strategies he was very reluctant to recommend anti arrhythmic treatment seeing this as overkill other matters of interest recent stress echo march indicated above average fitness for age 14 mets and reached a maximum heart rate of 160 bpm moderate aortic regurgitation grade 4 normal ejection fraction 60 lvedv 138 mls no demonstrable ischemia or arrhythmia the recent pacs are very noticeable and I feel every one of them I would appreciate a second opinion or advice on whether there is anything else I can do to stop them I am currently on atenolol 100 my creator 40 my effexor 74 my and valium my
output: hello premature atrial contractions or supraventricular ectopic are not harmful per se other than giving you symptoms so antiarrhythmics are not usually recommended so I do not disagree with your treating cardiologist beta blocker is the safest option available although not the most effective one and other options are ablation or antiarrhrythmics so trying behavioral techniques is a good option but if it troubles you a lot then you may request low dose antiarrhythmics like amiodarone for a short period of time but they may again come back after the drug is stopped since there is no atrial fibrillation or set supraventricular tachycardia antiarrhythmics are absolutely necessary but the benefit would be in you is just symptomatic which comes with the risk of side effects however you should have hotter at regular intervals like yearly with echo for aortic regurgitation or if you notice sustained ectopic or irregular rhythm implying development of fibrillation you may discuss changing atenolol to others like metoprolol and see if its help you should try to identify triggers like sleep or gastric disturbances alcohol or smoking if any particular medications which you are on stress etc also if not had recently thyearoid should be tested so in a nutshell antiarrhythmics may be avoided but if not tolerable symptomatically then may be tried I hope this helps