High PVC burden tied to increased risk of new-onset atrial fibrillation

The premature ventricular complex is one of the most frequent cardiac arrhythmias linked with cardiovascular mortality and morbidity. A high burden of PVC may induce cardiomyopathy, which harms the left ventricular systolic function. Moderate and high PVC burdens also raise the risk of cardiovascular mortality versus low PVC burdens. Apart from cardiovascular complications, PVC is also linked with ischemic stroke. Some case reports have shown that PVC may trigger AF via intracardiac tracing.

A recent nationwide population‐based study showed an association between PVC and an increased risk of atrial fibrillation. However, the association between PVC burden and new-onset atrial fibrillation has not been determined. Considering this, Po‐Tseng Lee from National Cheng Kung University in Tainan, Taiwan, and colleagues aimed to examine whether PVC burden is linked with new-onset AF.

For this purpose, the researchers designed a retrospective, single-centre, sizeable population‐based cohort study to examine the role of PVC burden and new-onset atrial fibrillation in Taiwan. Patients who were AF naïve with PVC and underwent 24‐h Holter ECG monitoring were included. They were divided based on the 24‐h Holter ECG report as a moderate‐to‐high burden group (≥1000/day) and a low-burden group (<1000/day). The mean follow-up time was of 973 days.

New-onset AF was defined as a first or new detectable event of either a paroxysmal or persistent AF.

The study led to the following findings:

• A propensity score‐matched analysis demonstrated that the moderate-to-high-burden PVC group had a greater risk of developing new‐onset AF than the low-burden PVC group (4.91% versus 2.73%).
• Multivariate Cox regression analysis revealed that the moderate‐to‐high PVC burden is an independent risk factor for new‐onset AF.
• The Kaplan–Meier analysis showed that patients with moderate‐to‐high PVC burden were associated with a higher risk of new‐onset AF.

The retrospective, single-centre, large population‐based cohort study confirmed the association between premature ventricular complex burden and new‐onset atrial fibrillation.

The study showed that younger patients with moderate‐to‐high PVC burden are at a higher risk of new-onset AF. The findings imply that patients with high PVC burden should be monitored closely for new-onset atrial fibrillation.

"Our study provides insights into the possible mechanisms between premature ventricular complex, atrial fibrillation, ischemic stroke, and heart failure," the researchers wrote.

Reference:

The study, "High Burden of Premature Ventricular Complex Increases the Risk of New‐Onset Atrial Fibrillation," was published in the Journal of the American Heart Association. DOI: https://www.ahajournals.org/doi/full/10.1161/JAHA.122.027674