I am a 50-year old athletic male with no history of heart disease and a zero calcification score in a recent heart scan. I have the prothrombin gene mutation and take enteric aspirin. I have a long history of very infrequent episodes of paroxysmal atrial tachycardia, usually occurring while relaxing in the evening following a stressful day. Recently this has evolved into more frequent episodes of paroxysmal atrial fibrillation. These always begin in the evening when my heart rate is quite low (60 or less). They tend to follow an earlier period of exertion or an evening meal, but they never start in the morning or during exercise. The first episode lasted five hours and resolved spontaneously in the emergency room. Subsequent episodes have tended to last 45-90 minutes. I have taken metoprolol on several occasions but it is not clear whether it shortens the duration of the episodes, and it makes me feel crummy and impairs my ability to exercise for a day afterwards. My review of the literature suggests that my fibrillation falls into a classic vagally mediated autonomic pattern and that beta blockers may be contraindicated. I enjoy hiking and climbing in the wilderness and am fearful about the consequences if an episode were to occur far from medical attention and did not resolve promptly. Would ablation have any potential utility in my situation? I would like to carry a medication which could be used if necessary to terminate an episode. Is flecainide the best option?