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BACKGROUND: High burden of premature ventricular complex (PVC) leads to increased cardiovascular mortality. A recent na-tionwide population-based study demonstrated that PVC is associated with an increased risk of atrial fibrillation (AF). However, the relationship between PVC burden and new-onset AF has not been investigated. The purpose of the study is to elucidate whether PVC burden is associated with new-onset AF.

METHODS AND RESULTS: We designed a single-center, retrospective, large population-based cohort study to evaluate the role of PVC burden and new-onset AF in Taiwan. Patients who were AF naïve with PVC were divided into the low burden group (<1000/day) and moderate-to-high burden group (≥1000/day) based on the 24-h Holter ECG report. New-onset AF was de-fined as a new or first detectable event of either a persistent or paroxysmal AF. A total of 16 030 patients who were AF naïve and underwent 24-h Holter ECG monitoring were enrolled in this study, with a mean follow-up time of 973 days. A propensity score-matched  analysis  demonstrated  that  the  moderate-to-high  burden  PVC  group  had  a  higher  risk  of  developing  new-  onset AF than that of the low burden PVC group (4.91% versus 2.73%, P<0.001). Multivariate Cox regression analysis showed that  moderate-to-high  burden  of  PVC  is  an  independent  risk  factor  for  new-onset  AF.  The  Kaplan–Meier  analysis  demon-strated that patients with moderate-to-high PVC burden were associated with higher risk of new-onset AF (log-rank P<0.0 01).

CONCLUSIONS: PVC burden is associated with new-onset AF. Patients with moderate-to-high PVC burden are at a higher risk of new-onset AF.

REGISTRATION: URL: https://www.clini caltr ials.gov; Unique identifier: NCT03877614.

Key Words: 24-h Holter ECG ■ new-onset atrial fibrillation ■ premature ventricular complex ■ premature ventricular complex-induced atrial fibrillation