Impact of Premature Ventricular Complex Burden on Ischemic Stroke in Patients with Non-Valvular Atrial Fibrillation

Background/Objectives: Limited data are available regarding the prognostic impact of premature ventricular complex (PVC) burden in patients with atrial fibrillation (AF). We sought to compare clinical outcomes in patients with AF according to PVC burden via 24 h Holter monitoring. Methods: From January 2010 to December 2020, 4834 oral anticoagulant (OAC)-naïve non-valvular AF (NVAF) patients who underwent 24 h Holter monitoring were included for analysis. Results: Among the 4834 OAC-naïve NVAF patients, 2835 patients (58.6%) exhibited at least one PVC within a 24 h monitoring period, and 120 patients (2.5%) displayed a daily PVC burden exceeding 10%. In the follow-up echocardiography, patients with a daily PVC burden of ≥10% exhibited lower left ventricular ejection fraction, larger left atrial volume, and higher right ventricular systolic pressure and E/e' than those with a daily PVC burden of <10%. The risk of ischemic stroke (adjusted HR 2.332, p = 0.015) and heart failure admission (adjusted HR 2.147, p = 0.010) were significantly higher in the patients with a daily PVC burden of ≥10% than in those with a daily PVC burden of <10%. However, the incidence of cardiac death was not significantly different between the two groups. A daily PVC burden of ≥10% was independently associated with the risk of ischemic stroke in the OAC-naïve NVAF patients, irrespective of the CHA₂DS₂-VASc score, AF type, and left atrial size. Conclusions: The current results suggest that evaluating and monitoring the burden of PVCs in patients with NVAF is an important aspect of predicting stroke and heart failure admission.