PVC, betablocker and Holter
I had a heart attack back in 2019 resulting in some myocardium necrosis and 2 stents. Early this year (2021) some PVC were detected on an ECG and confirmed with a 24h Holter (8% vent., 3% atr.). I was originally prescribed Metroprolol (Apo) twice a day after my heart attack, at 50mg first, but rapidly reduced to 37mg by my GP after I complained getting out of breath too easily.
Now, my cardiologist wants to push Metropolol back to 50mg in an attempt to curb the PVC frequency (which are however considered benign if I am not wrong). So I asked her if she planed to have an Holter done few days after this new regimen to see whether this mod had any beneficial effect on the PVC occurrences. She answered no, arguing that monitoring my shortness of breath threshold would be plenty enough.
I have two questions:
1. Should not PVC-positive 24h Holter results be systematically confirmed my a multi-day assessment, since I read that PVC frequency can have a high day-to-day variability?
2. Since her logic of not having me take another Holter once the beta-blocker has been increased completely eludes me, could somebody knowledgeable in this field please enlighten me about what could be her rational for not monitoring the effect of her increasing the beta-blocker on the intended target (the PVC frequency)?