I get frequent pacs with raise in hr (exercise/sex). bp normal. resting hr in 60's. echo/ekg clear. holter/30 day monitor show nsr w/ skipped beats. some sinus tachycardia. no pacs before last year. frequency gets worse as hr increases. ideas?

From the sound of it you've already had a cardiologist evaluate you, is that correct? Have you had a stress test? If you have ongoing concern or are otherwise symptomatic I would consider that, or referral to a cardiac electrophysiologist. I definitely recommend avoiding any stimulants such as caffeine, as well as alcohol.

If your heart has been felt to be structurally normal, PAC's are considered benign. This is expecially so if the echo shows a structurally normal heart. That being said, it is always better to be sure with the help of an electrophysiologist's opinion. An otherwise normal heart may show arrhythmias if you on medications for other conditions such as asthma (use of inhalers). Get a cardiology exam.