Healthy, somewhat young, consistent PACs at 33% burden rate

PACs are common, but not when the burden approaches 10%. You're higher. They can come on as a result of a failed catheter ablation, signalling the onset of atrial fibrillation later, maybe months later. AF can bring on PACs or come from them. So, while most people have the odd PAC, as their number rises they become more intrusive and problematic.

Yes, a catheter ablation in the right hands, experienced and skilled hands, can solve the problem of too many PACs. That you are largely asymptomatic, and that your heart's vessels show no enlargement or other unwanted morphology suggests that you have no hypertension or collagen deposition and fibrosis in your substrate (meaning wall thickening and loss of flexibility in the underlying muscle tissues). So you're ahead of the game in that respect. However, arrhythmias tend to be progressive in nature; certainly AF is, and as I said early, AF and PACs are kissin' cousins. My point is that, with the high burden you have been formally given, you should consider a mechanical intervention like catheter ablation. Just do your homework first and interview at least two really good EPs....please....if possible with your time and resources.

Have you tried something as simple as a low dose beta blocker?

A few years back I was having trouble with frequent PAC and PVC, and a series of doctors simply shrugged them off. Nobody even used a term like "burden rate" to me. Holter monitor analysis simply ignored them. Visit to hospital for another reason, hooked to the electrodes, was lighting up the PAC and PVC like a Christmas tree, nobody cared.

But, after a couple of years, some combination of diet, beta blockers, time and luck, and the problem seems to have been reduced by 98% or so. So were the doctors right to shrug it off? I doubt it.

@carbcounter
My experience is very similar. I was just prescribed a mild beta blocker and hope it reduces my PVC burden like it did for you.

The good news is that if the beta blockers are going to work, they work like the first day! I suppose it might depend on just which one you're on, and you might need to adjust the dosage, up or down - I had to adjust mine down, a standard dose was too much for me.

And on the dietary side - how is your diet on vitamin A? Do you take a multivitamin? If you're on the beta blockers for even a few days without improvement and there's any chance you're not getting enough vitamin A, go to your supermarket and grab a bag of "baby carrots" and have one with every meal. See if that help! It helped me. Took just a few days, at least before I noticed. I didn't expect it, I just thought I should have more vitamin A on general dietary principles, and who knows maybe it was a coincidence? But there are no coincidences, lol. Anyway I'd love to hear, positive or negative, from anyone else who can put it to the test.

My PAC burden is in the 10-12% range, probably a byproduct of open heart surgery to replace my mitral valve. My Mayo Jacksonville cardiologist said once it gets into the 20s they will address it as at that point heart damage could occur, so an ablation for you seems reasonable. I have had two of those too, piece of cake. My only advice is to go to the best facility you can and follow their direction.