You can take drugs prophylactically, as in preventatively, or you can take them for acute episodes such as runs of tachyarrhythmia. I don't believe PACs constitute a tachyarrhythmia, but they are ectopic in nature, so premature. The reason they are troubling for the patient is that they tend, across all patients (unlike atrial fibrillation, or AF, and flutter, FL) to be symptomatic. Some patients have no idea they're fibrillating, but pretty much all of us know it when we have a PAC or ten of them. This is because the heart compensates with an extra beat when it catches up, and that extra beat is a real thumper....which you know only too well.

Pill-in-pocket (PIP) is one way to deal with episodic cardiac arrhythmias, whether to stop them or just to slow them when they do happen. For example, flecainide is an anti-arrhythmic drug that is routinely prescribed as a PIP for those who only have one or two episodes each month, but who don't want to routinely take the drug and who don't really profit from it if their heart behaves 98% of the time. This is understandable. So, if....IF...you break into AF or PACs, pop the pill you have wrapped securely in your purse or wallet, and go about your business. It should work inside of 40 minutes.

That's rhythm control...or rather arrhythmia control. For RATE control, metoprolol, bisoprolol, diltiazem,...these are examples of calcium channel and beta adrenergic blockers that are meant to do two things: slow the heart's beating rate, but also to make each contraction a little weaker than before the pill's effects. This is why metoprolol, as an example, is sometimes issued for 'incipient' hypertension. It might slow the heart some, but it also makes each ventricular contraction less strong, meaning the blood pressure arising from each systolic stroke event is reduced....reduced blood pressure....which is the intention.