Atrial Tachycardia and Failed Ablations/Meds

Here is my situation. I have Atrial Tachycardia/SVT. I had a 14 day Holter that showed a 20% average burden of Supra ventricular Ectopy. I had an 11% burden of SVT. I had, on average, 20-30,000 ectopic beats every day, and 6-700 runs of SVT per day. Most of my episodes occur at night. From 10pm to 6am, my hourly burden of PACs/SVTwas 30-80%. It starts in the evening and then keeps me awake constantly. The meds have all been a disaster. I have had two ablation attempts with failure to induce.

Had my follow up today for the post-procedure Pericarditis. The EP wanted another 3 day Holter while on the Metoprolol, not sure why, maybe just to confirm my claim that the Metoprolol wasn't working. It was confirmed.... Still have 20% burden of SVT/Ectopics, with an additional 11% burden of tachycardia, and 500 or so episodes of SVT per day. The runs were shorter on the Metoprolol, but that is about all that changed. So he said I could just stop the Metoprolol. The only plan for now is to try the TENS vagal stimulation (which he was fine with), take Propranolol for sleeping, and call him if it gets worse. The next med to try is Sotolol. For now I am just going to wait and see. I'm tired of the meds. He thinks it could be from increased vagal tone but the Norpace doubled my SVT.

I honestly don't know what to do. The meds are all worse than the heart issue. The ablations have been a failure. Unless I can get someone to do an ablation at night, when I am actually having the SVT. I am hesitant to try that again. But the massive amount of PACs/SVT are super terrible too. Any suggestions? Thoughts? I know that SVT won't kill me, but it sure feels like poo.....

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