PVC’s with no end in sight.

Heart arrhythmias, most especially when we're acutely aware of them, are indeed anxiety inducing. I am an atrial fibrillation patient, although after the second of two catheter ablations, I am free of AF, now going on 32 months. But I was a long distance runner who became highly attuned to my body, and as soon as I would start fibrillating I would feel the anxiety and the thumping in my chest. It was awful. People told me I was looking distinctly grey in complexion. That's all in the past, at least for now (ablations for AF tend to last only a few years and then a second or third is needed, or the patient just has to accept living with it).

I don't know a great deal about PVCs, although I had a lot of PACs between ablations. I do understand that it's an electric disorder, and I believe certain electrophysiologists who specialize in complex cases of arrhythmia can deal with PVCs via catheter ablation. In the very worst cases, no matter what the arrhythmia is, they can nuke the AV node and implant a pacemaker. That's usually the last option, but it's not like there aren't one million Americans living with pacemakers today...and quite happily, thanks very much.

You should consult an EP at your earliest opportunity. The key is the anxiety, or generally the lack of quality of life. Often the specialists want to improve how you live if they can't formally address the defect or disorder and stop it dead in its tracks. AF, what I have, is a progressive disorder. I wouldn't be surprised to learn that PVCs are at least part of a progression toward a disordered heart (without having bothered to look it up, but you can). My point is to take concrete steps to stem the PVCs while you can, while your disorder is early in its stages, and that is what you would want to discuss with the EP. Your goal might be simply to stop the premature contractions, but ideally it's to help you to live more carefree, peacefully, and to sleep better, to live more happily, without the doom and gloom. Tell your cardiologist that you would rather deal with this problem aggressively to stop them from happening since they make your life so miserable. If he/she won't offer to refer you, seek out an EP on your own behalf. Then, visit yet a second EP and get that all-important second opinion. If they both jive, then you're probably on the right track in terms of what can/should be done.

Troponin is a protein indicating disrupted myocyte tissue. If it's above a threshold, it means the heart muscle is damage here, there, wherever and it needing to repair itself. My own troponin levels were elevated after spending a few hours in AF, but they weren't scary levels, only mild indications of some minor repair going on. I would suspect that aged hearts see higher and higher levels of troponin the more issues they have, but that's where I'm way below my level of expertise...which is near zero as a layman.

Last comment: you live in your own skin. If it is no longer pleasant, advocate on your own behalf to get crackerjack experts, even if you have to travel to the best ones, to intervene for you. Happened to me and to literally 10M other Americans (I'm Canadian) in the past five years, some of whom only need minor medications or lifestyle changes, some who need pacemakers, some who can have day surgery, an ablation, and be done with it for the next 5-10 years...or longer.

@gloaming thank you so much for your response. I guess the hardest part for me is dealing with the anxiety part of the PVCs. I have multiple doctors telling me not to worry and yet, that’s all I do. I feel okay, except when I constantly reach for my wrist to check my pulse. It is quite a battle.
Thank you for your thoughts and shared experience. It was kind of you to respond, and I am grateful.

My PVC’s were 8% of my heartbeats. My EP said that 8% was enough to lead to eventual heart failure over time as a result of the heart having to compensate and work harder. He is renowned in his field and works for the Hospital of the University of Pennsylvania.
I had an ablation and my PVC’s are now 1% of my heartbeats- a harmless number.
You can do the math based on the number of PVC’s you are having per minute compared to your pulse - your total number of heartbeats per minute. To keep it simple, here’s an example: 8 PVC’s per minute with a pulse of 100 total heartbeats per minute would be a burden of 8% PVC’s. Of course, this calculation would only be a snapshot of that particular minute in time.
I was told 50% of the adult population have some PVC’s but have so few of them that they are harmless. Depending on the number you have, yours may not be harmless.
You should wear a monitor for a few days to get a definite idea of what your heart is doing. Don’t ignore it. See the best EP you can find at a major teaching hospital. Good luck.

@tdriver I would recommend a two pronged approach to dealing with your anxiety if that is the chief concern for you: self-education where you read and read and read, sleuth out yet more papers submitted to NEJM, HIH, BMJ, American Cardiac Association, etc, and the other is to consult with a psychotherapist who specializes in CBT (cognitive behavioural therapy)...and that's just me guessing what might work. A good psychotherapist will probably have other tools to teach you to manage your anxiety. Works for tens of thousands each year.

@wcuro that’s interesting that your doc said 8% PVC burden is enough to cause problems. My cardiologist said 10-15%. I was only at 5.6% at the time (based on a 10 day MCOT EKG study), so a comfortable margin from 10-15%, but if 8% is the number I’m closer than I want to be! I’ll add another question to my ever expanding list for my next appointment! Glad to hear the ablation improved your situation so much.

@kellyb1960 https://www.ahajournals.org/doi/10.1161/JAHA.122.027674
https://www.ccjm.org/content/83/7/524
This third article, fairly recent, gets to the nub of the question, how much of a PVC burden begins to invite pathology, and it's a longer read:
https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.119.042434
I'll quote the most salient and relevant text as far as I am concerned:
'...It is clear that there are many patients with frequent PVCs who never go on to develop systolic dysfunction or clinical heart failure. There is therefore tremendous interest in identifying individuals at risk. Most of this work has arisen from series of patients presenting for catheter ablation of their PVCs, and more work needs to be done in the community-based settings to better inform decision making in the general population. Among patients presenting for clinical care for their heart failure and PVCs, a higher burden of PVCs has consistently been shown to be an important risk factor. It is important to emphasize the origins of this group (constrained to those presenting for clinical care, primarily to cardiologists), where the proportions of individuals with heart failure in the setting of PVCs is likely inflated in comparison with the general population. Although there is no clear single threshold cutoff, studies have suggested that optimal test characteristics for a PVC-induced cardiomyopathy occur at PVC burdens of 16% to 24%24,66 and that most cases of PVC-induced cardiomyopathy occur at burdens >10%.24,66–69 However, consistent with evidence that those with 6% PVCs can experience benefit in reducing their systolic dysfunction with catheter ablation, the reality is likely more complicated and nuanced, fitting with our previous community-based observation that the risk simply increases proportionally with burden...'

Note that a burden of 10% is stated as the usual demarcation point for most patients, but that some with burdens well under that may begin to slide into markedly poor cardiac health. So, the patient, as unique as each case is, really matters...not the articles, the policies, the insurance and its policies, etc.