Hi Sarah,
Gosh, I can just feel what you're feeling right now! I've been through this same experience so many times (these periods come and go, often with long spells of quiet in between, but when they're happening it seems like forever). If I had had an ablation it would make me more sensitive to it, too. This is what happens with my daughter when she starts having some blips - there is a very rational, if incorrect, assumption that "they didn't get the whole thing" and she'll have to go back for a second pass - and who would want to do that?? Me, I had open heart surgery instead, and it wasn't to make the PVCs and PACs go away - but to keep me alive after my right coronary artery came apart during a routine angiogram. This is not normal! In fact I was at that time spending a lot of time doing research in the library at NIH and was able to calculate just how likely my combination of bad luck was: a likelihood of .00017 per cent. Easier to win the lottery or get struck by lightning. Lucky me! Anyway, after that was all over with and I was back home, I started having more and more PVCs til I honestly thought I would go insane. The doctor heaved a big sigh, explained to me that the heart doesn't like being handled (literally, as in surgery - you know, those pesky fingerprints and all) but slapped another Holter monitor on me and we came up with a 24-hour total of 5,780 PVCs and a few PACs as well during the period. My first thought was "I'm dead." Followed, rather quickly, by "This will never hurt me - there's hardly time in a day to squeeze any more of these in, and I slept through the night just fine!" After that I kind of let go of it and lo and behold, they went away. Since then they've come back from time to time, sometimes in a really annoying and unnerving pattern, but my wife pointed out to me the other day that I can't seem to have two illnesses going on at once, and that when I got a bad cold recently the PVCs disappeared until I was better. It was true. And yes, we actually can "talk" ourselves into more of these than we might otherwise notice. Unfortunately once we've had a few we become more tuned in to our heart's activity. This starts the cycle of adrenaline release (there is a little thrill of fear each time we feel one, and that "thrill" is adrenaline dumping into the blood stream). This does not mean that it is impossible that you might actually have a tiny, missed bit of nervous tissue "shorted out." HOWEVER....what argues eloquently against this likelihood is a)that rarely happens anymore, and more to the point b) you would be having actual episodes of tachycardia, because that is how AVNRT works. Once it takes off on you your heart will run like a racehorse until another PAC (and that's what sets those off) breaks it off or you perform a valsalva maneuver (I don't know if you know about that or not, and hesitate to go into it unless your doctor educated you about it - but it won't work for isolated PACs nor at all for PVCs anyway). It really sounds like you are a normal anxious person, and no, those are not mutually exclusive terms. Normal symptoms for an anxious person, with or without a history of AVNRT, SVT and an EP ablation. Adrenaline is the anxious person's drug of no-choice (take it from me) and it is potent! It's very easy for me (or anyone else) to tell you "just let it go....get your mind on something else....etc. etc." It's true, it works, but it's a skill that's very difficult to learn and apply. On the other hand, have you had a 12-lead EKG recently? I forget. I know you were told you have incomplete RBBB, which you can't pick out (unsurprisingly, as it is hard to recognize. I've been doing this stuff for over 30 years and I still miss it sometimes). There is also a clue to AVNRT that shows up on EKGs but my eyes aren't good enough to see it most of the time, even with glasses on! Still, a good cardio guy should be able to put your mind at ease about that particular thing, and if not that way, with a Holter monitor for sure. It might be time again. It might be worth the aggravation. But unless you actually experience an episode of runaway tachycardia at a rate above 140 - 150 beats per minute, it is highly unlikely you have anything left of the original derangement and are just being "normal" like the rest of us. Doesn't help much, does it. Wish I could wave a magic wand and just make it go away. Some people actually live in a constant state of ventricular bigemeny as their "normal" rhythm! This would mean roughly 51,000 PVCs in a 24 hour period. ACK!! I don't even like to think about that! Point is, "isolated" and "frequent" are very relative terms, and sometimes we don't read the literature the same way a doctor does. Anyway, it honestly doesn't sound like anything bad is going on, I do believe a new Holter test might help reassure you, and not much anyone can say will make you feel better while you're in the midst of one of these "irritable" periods. I have been having them start when I get up and walk (the usual rule is the opposite for most people, but it can be reverse, which is worse, because then we start to NOT walk if we can help it, get more nervous, out of shape, and more aware of our heart's activity). That's why I went to the gym last night and got on the treadmill for a half-hour. They started right away, I got a little uneasy, but I've got more experience at this (42 years worth) than you so I finally was able to walk my way through it. They're gone now. Again. They'll be back. I know that. But for right now I feel fine and I got some exercise as well. Tough advice to give, especially since, once again, I feel exactly what you're feeling - I know precisely what it is - and I feel for you. I just wish there was a way to turn it off. Meditation is the only thing that's worked for me consistently. Good lord, I talk WAY too much! Anyway, hope it passes soon and you start feeling like yourself, and don't hesitate to drive the doctor crazy if necessary. Reasurance is 90 per cent of the game here!