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October 17, 2025Open Access

Premature Ventricular Contraction-Mediated Ventricular Fibrillation: Clinical characteristics, Application of Machine-Learning Algorithm and Outcomes of Catheter Ablation: Multicentric Case Series

Key Points

Individuals with PVC-triggered VF experienced significantly more early repolarization compared to controls, indicating potential markers for risk assessment.
After catheter ablation, 82% of patients remained free from ventricular tachycardia or ventricular fibrillation over a median follow-up of nearly 400 days.
A machine learning algorithm demonstrated robust discrimination for PVC-triggered VF, achieving an AUROC of 0.85, highlighting its potential clinical utility.
ECG characteristics, such as QRS notching, were more prevalent in PVC-triggered VF patients, emphasizing their relevance in identifying high-risk individuals.

Abstract

Background: Premature ventricular contractions (PVCs) are common in patients with and without structural heart disease. In a subset of patients, PVCs are associated with malignant ventricular arrhythmias including ventricular fibrillation (VF). Methods: We analyzed data from an international cohort of 61 patients who underwent catheter ablation for PVCs (41 with PVC-triggered VF, 20 controls). We evaluated the prevalence of ECG characteristics in patients with PVC-triggered VF including (a) early repolarization (ER) in inferior/ lateral leads and (b) QRS notching of the sinus beat or PVC. We evaluated whether a machine learning (ML) ECG algorithm (Factor ECG) could discriminate between individuals with PVC-triggered VF and individuals with PVC and no history of VF. Explainability analyses were performed to identify which components of the ECG waveform were associated with risk prediction. Results: In 41 patients with PVC-triggered VF, there were a median of 8 ICD shocks/per patient prior to ablation. The mean coupling interval of the PVC to the antecedent sinus beat was 313±130 ms. When compared to controls, early repolarization (39% vs. 20%) and QRS notching (71% vs. 25%) were significantly more prevalent in individuals with PVC-triggered VF. After a median ablation of 1 IQR: 1-3), 82% of patients remained free of VT/VF,ICD shocks over a median follow up of 400 90-2490 days. The ML ECG algorithm demonstrated reasonable discrimination of patients with PVC-triggered VF compared to PVC without VF (AUROC 0.85 0.56-1.0). Anterior ST segment deviation and left bundle branch like delay were salient contributors to ML-based prediction. Conclusions: In patients with PVC- VF, routine ECG parameters including early repolarization and QRS notching were present in up to two-thirds of patients and were more prevalent compared to individuals with PVC without VF. An ML-based ECG algorithm effectively distinguished between PVC-triggered VF compared to PVC without a history of VF.

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