How do you determine PVC burden?

You need a full time monitor to correctly get the percentage. The burden is the percentage of total beats that are PVCs (or PACs) is found by dividing the total PVCs beats for an extended time period by the total beats from that time period. So for example say your HR is 70/minute.
In a 24 hour period that would equal 100,800 beats. If your PVC beats = 20,160 that would be 20,160 divided by 100,800 beats which = 20%. A longer period on a monitor would give a better reading. Last spring I had an extended period of PACs. I wore a monitor for 2 weeks and the burden during that time was 24%. Ouch.

What did they do for you at 24 percent!!??? Ablation?

That’s a lot of Flecidine 300 mg a day isn’t it ?
Is it working for you ?
I get PVCs often , but usually caused by gastrointestinal 7 chronic illnesses.
Gastro Cardiac syndrome.
I used to get them when younger too but more at time of my periods and when pregnant 2 x . Horrible.
I’ve also had 2 long, 2 hr episodes of A fib last 2 years. Very diff and also very scary feeling ! Erratic.
Today I’m suffering since last night w/ all my digestive disorders and more like long QT with my heart ♥️.
It’s also very scary as long pauses in between.
This is not typical for me .
I take Heart Calm supplements for PVCs / PACs .
Took for this but really isn’t helping a lot .

Yes I have a loop recorder implant but I feel like it doesn't do anything..by the time it connects its passed. Plus i never hear from my doctor after a transmission so i guess its not life threatening

This is mine when its bad... the max is 400mg a day for fleccinide but my doctor told me : you want to tske a pill or you want to have surgery?

My EP is one the top EPs at a large university based medical center. Been in the field over 35 years and says he does not do ablations for PACs. He says that you have be in the area of the heart when the PACs are firing. They cannot be mapped like Afib. That said he just did my 2nd Afib ablation on Sept 25th and said he was able to reach both the front and rear side of the heart. He said he was hoping that maybe he was able to help with the PACs even though his primary mission was Afib. He was satisfied that I should see an improvement with Afib and he was very humble and careful with his wording that I "might " see some improvement with PACs. Fortunately my PACs have been more intermittent the past few months since I had that monitor reading.

Wow, A fib and PAC’s . So glad you had the 2 nd ablation for A fib . Why 2 though ? Did first one not work?
Yes , I have heard that now that you mention it about PAC’s no ablation.
Just if high percentage of PAC’s .
I have low percentage but I feel each one . I had the 2 hr A fib events a year apart. This morning I had like long QT thing going on that was scary for a bit ( that usually never happens).
All scary to me !
I have Gastro Cardic syndrome and like I said I’m chronic with 7 diff gastrointestinal issues daily .
It’s just horrible. All of it .

Your burden is high. What makes it very important to treat is:

a. How it makes you feel, how symptomatic you are, how intrusive the PACs are, and if they interfere with your quality of life severely, or even detrimentally, as YOU define it....not the EP; and
b. What your overall condition, age, co-morbidity risk and burden, and cardiac condition are.

It is true that most EPs are averse to intruding on the heart just for PACS. You can live forever with PACs, just as you can with intermittent, or paroxysmal, AF. However, any dysrhythmia is eventually a problem, usually because they tend to morph or to progress, and they usually ARE associated with other co-morbidities, or they encourage their onset. Nasty in a way, and worth considering.

I have read recent research that even a 2% burden of PACs is associated with higher morbidity. That should not be surprising because any dysrhythmia is a sign of an electrically disordered myocardium.

Depending on your body weight, about 300mg of Flecainide a day is about the max you'd want to HAVE TO take...ideally. Like metoprolol, there is published literature saying 200mg a day is the upper prescribing limit before you have to look at other remedies, but then the same article said that if one is in heart failure that the upper limit is 400mg PO. Well, ummm....that's exactly twice, or 100% more than the max recommended dosage for those in flutter or AF. What gives!? They're guidelines with lots of room for discretion by the prescribing physician, if not all that highly favoured by insurance industries that might have to pay in a law suit.
So, back to Flecainide, if your body weight is over 80kg or so, (175 lbs) [I need to verify, but it's close], then you can take up to 300 mg PO, but those under that weight, especially most women, should be taking less....always what is prescribed, though.

Lastly, it could be that your EP wants to hammer your heart into calmness, into submission post-ablation. Maybe he feels the PACS are a typical post-op sign of an irritable heart. So, he's sure he's doing you a solid, if you know what I mean. In my inexpert opinion and from readings, Amiodarone is often the drug of choice when a cranky heart acts up immediately after an ablative procedure for arrhythmia. But, I'm not paid and nobody asks me...probably a great thing. 😀

I appreciate your thoughtful response. I have come to accept ( As a believer in Christianity) that if anything happens to me I'll be in a better place. This has helped tremendously with the fear, so now what i deal with is anger and frustration when they happen...more like a fly buzzing around constantly annoying me. Ideally i don't want to have to rely on medicine to function but at this junction I have no choice...

My PVC burden is about 30% and scheduled for an ablation next month. I had a monitor to determine the burden and was shown just where the pvc was happening in my heart. that means an ablation area is pinpointed to that area. There is testing to determine if your PVCs will be helped by ablation & if your are symptomatic. I am very fatigued and unable to do many things I once did so praying this will be the answer.