Frequent premature ventricular complexes and risk of atrial fibrillation, heart failure, stroke and mortality: a meta-analysis.

BACKGROUND/AIM: Frequent premature ventricular complexes (PVCs) have historically been regarded as benign in structurally normal hearts, yet emerging evidence suggests substantial cardiovascular risk. This meta-analysis aimed to quantify associations between frequent PVCs and incident atrial fibrillation, heart failure, stroke and all-cause mortality in adults without established cardiovascular disease.

METHODS

PubMed/MEDLINE, Embase, CENTRAL, Web of Science and Scopus were searched through February 2025. Databases were searched from inception to February 2025. Eligible studies employed standardised PVC assessment methods with a minimum 12-month follow-up reporting adjusted effect estimates. Data were independently extracted and quality was assessed (Risk of Bias in Non-randomized Studies of Interventions) by two reviewers. Random-effects meta-analyses yielded pooled HRs with 95% CIs and prediction intervals (PI). Study-level meta-regression was used to evaluate dose-response relationships, and heterogeneity sources were explored via further meta-regression.

OUTCOMES: 20 articles (17 studies; 26 783 590 participants) were analysed. Frequent PVCs were significantly associated with increased risks of atrial fibrillation (HR 1.69, 95% CI 1.39 to 2.05; PI 0.91-3.12), heart failure (HR 1.73, 95% CI 1.50 to 2.00; PI 1.18-2.54), stroke (HR 1.28, 95% CI 1.10 to 1.50; PI 0.90-1.82) and all-cause mortality (HR 1.31, 95% CI 1.10 to 1.56; PI 0.79-2.18). Heterogeneity was substantially reduced in sensitivity analyses restricted to Holter-quantified PVCs. Meta-regression identified a 5.4% increased atrial fibrillation risk per 1% increment in PVC burden.

CONCLUSION

Frequent PVCs confer significantly increased cardiovascular risks in populations largely without overt structural heart disease, though baseline cardiac assessment varied across studies. Patients with frequent PVCs (≥500/day) may benefit from periodic echocardiography and rhythm monitoring to detect early structural or arrhythmic progression. Randomised trials are needed to determine if PVC burden-guided interventions can reduce cardiovascular risk.

PROSPERO REGISTRATION NUMBER: CRD420251006111.