I wish I could allay your fears about ablation. I'll try, and I have had two of them, both by the same gentleman doctor. I know of a person who runs the affibers.org forums who has had at least six ablations. He was desperate and sought out Dr. Andrea Natale at the Texas Cardiac Arrhythmia Institute in Austin. That was his last ablation. He still runs the show at affibers, answers tons of questions, and has been free of arrhythmia ever since being signed off by Natale. I hear good things about Dr. Pasquale Santangeli at Cleveland Clinic.

Ablations are something like getting a colonoscopy, except there's no bowel prep. The process is largely the same, except you get a trans-esophageal echocardiogram tube put down your esophagus, and not up your bum. Then, they make a small incision in your bikini waxed area, literally, and feed a small, thin, but long, tube up the vein and into your right atrium where all the body's spent blood empties into the heart. From there, they pierce the septum between that atrium and the one next to it, both atop the two large pumps, the ventricles. When in the left atrium, they probe and find where unwanted extra signals are entering the endothelium, the lining of the atria. The atria are not enervated, not like your big muscles. Instead the signal to make them contract runs along their inner surface, it being endothelial tissue. The signal issues from the 'sino-atrial node' in the right atrium and travels to the other atrium, causing both to beat. In the case of atrial fibrillation, or tachycardia, those nodes' signals get confounded by different pathways that the heart develops.

Probably the worst part of an arrhythmia, besides how they intrude on our body's normal sensations, is the anxiety and their intrusiveness, especially into good rest. Those run in what engineers call a 'reinforcing loop', which just makes them so debilitating. In the right hands, tachycardias, arrythmias, and PACs can be cut off from impacting both the heart's normal rhythm and one's well-being. This puts the onus on the patient to do the correct type of sleuthing to find to whom they can travel reasonable and be seen in good time, but who also will quite probably stem the dysrhythmia in question.

You want a middle-aged EP, electrophysiologist, who has performed 1500-2000 ablations, who does at least six to ten each week, and who, when asked, will claim that their success rate for an index ablation (first ablation) runs at 75% or higher. I didn't have to ask mine; he told me when we first met. It doesn't sound like a great record of success, but that is the running average across the industry. This means some EPs have worse rates of success, while others enjoy a much better reputation. Natale and Santangeli are two examples of the latter, There are other really expert and highly skilled EPs in the USA, but I don't know of them.

Knowledge is power. Learn! Find out what kind of success two or three EPs estimate THEY have of ridding you of PVCs. Learn why it's tricky to treat PVCs versus PACs or AF. Then, do a risk analysis on yourself. Can you stand the burden, and the enlargement of the vessels involved, and maybe the eventual heart failure/heart insufficiency? What do trusted friends say when you ask them to do some reading and advise you?