Cardiologist doubled my metoprolol to treat PVC

I am glad to discover this site. A little history...

In the spring of '22 started having SVTs in my upper chamber. I had 2 ablations that summer neither one worked for more than two weeks. In November 2022 I had a pacemaker implanted and my 3rd ablation for SVTs. That solved issue until last summer when I began to have minor arrhythmias in my lower chamber and they have increased. After the pacemaker I was prescribed metoprolol succ 25 mg per day. My cardiologist increased my metoprolol succ ER twice within the past month to 50 mg twice a day, to 100 mg per day. Yesterday, I was at my EP and he said I should either treat have this problem treated with medicine or have an ablation. Has anyone else had an issue similar to this? Are these arrhythmia issues just persistent and continuous.

I apologize for the length of this post.

My posts get lengthy and have become burdensome to me about atrial fibrillation, arrhythmias, their progressive nature, and that the real risk lies in either stroke or heart failure, with the latter term an unfortunately doom-laden one that sounds worse than it really is. However, as I just stated, most disordered hearts electrically tend to progress toward worse states or levels, and eventually all that's left is a pacemaker if nothing else is done to control the arrythmia...whichever one it is. The problem really is that the one chamber must bulk up its mass of myocytes in order to keep up. In the case of atrial fibrillation, the left atrium enlarges and thickens its muscular wall. This has the effect of causing stretching inside which causes fibrosis, or scarring. This encourages yet more fibrillation. Or, the stretching causes the mitral valve between the left atrium and ventricle to prolapse, which also tends to encourage arrythmia and wall-thickening. The point of all this is that the wall-thickening is only helpful to an upper limit after which the muscle thickness actually begins to hinder itself, and the heart loses efficiency in pumping. This insufficiency is called 'heart failure'.

Please note that people can live many years with either condition, the heart failure and/or arrythmias....except for ventricular tachycardia...you do not want that...at all...at all. It's just that there will be a gradual decline, and that is what all of us would want to avoid if possible. So, you take a DOAC (Direct Oral Anti-Coagulant) daily to minimize the risk of stroke from improper circulation in the heart (chiefly the left atrial appendage), you take a beta or a calcium channel blocker to reduce heart output (don't make the heart beat so strenuously, even at rest), but the blockers also slow the heart rate when you are in arrhythmia, and you may need an anti-arrhythmic drug like Multaq, Flecainide, Sotolol, propafenone, Diltiazem, or others...several others...and whatever you tolerate that helps you at the same time.

Unfortunately, there seems to be a wide disparity between the quality of training, and also in the experience, of all the electrophysiologists out there. The top tier ones are very busy, highly sought, and are exceptional with an exceptional record of success. However, even they frankly tell their first-time ablatees that they will probably be back for more work. And they do come back, whether in months or years. I had two ablations months apart because the index failed inside of six days.

To conclude, and to answer your question, yes, left unmanaged, or left improperly treated by drugs or by surgery, the tendency over time is for arrythmias to become persistent and then permanent. I strongly suggest you consider looking further afield for another, better, electrophysiologist. Find the best two days' drive away if necessary.

I had severe episodes from age 14 to 19. Read in newspaper column that some people are SEVERELY sensitive to caffeine. After quitting coffee etc, I had NO problems for YEARS, until lately without thinking I was eating coffee ice cream from the US. Once I put 2 plus 2 together, I stopped the coffee ice cream and fine. That med you are taking has bad side effects. At age 75, I take NO meds for anything. I investigate the CAUSE of the problem.

Hi @gloaming,
Thank you so much for the information you shared. This issue is hard for me to make sense of and your explanation is helping to clarify the big picture. I also appreciate your comment on the doom-laden term 'heart failure'. And further input about living many years which I hope too at age 69, turning 70 this summer.
I am currently looking for an EP. And, yes I would drive two days away if I could get in to see the proper doctors! I am originally from WI. My husband and I were going to spend the month of July in Rochester, MN this summer to escape the TX heat. But because of my arrhythmia issue we canceled our plans. Currently, I am attempting to get an appointment with a different EP in Austin or Houston, but I am waiting for a call back. Maybe I should have kept the plans for Minnesota and tried to see a doctor there. Here, in TX it takes about a month to get an appointment.
I do have another question. How do you go about finding the best cardiologists and best EPs? I went to TCA (Texas Cardiac Arrhythmia, supposedly world renown) in Austin and had two ablations done and neither one worked more than two weeks. The doctor I had in Austin was highly recommended by several people I knew. (I guess that situation is similar to what happened to you. Sometimes they just don't work) Anyway, if you know how I can find out about a doctor who specializes in lower chamber ablations please let me know.
I do appreciate your sharing. Thanks for listening to my ongoing search for a remedy to this problem. It's complicated.
Thank you.
Ruthie

Thank you for your comment.
I think it is remarkable to be 75 and take no medicines for anything!
You are very fortunate.