Impact of catheter ablation for atrial fibrillation on cardiac ventricular electrical activity: assessment of premature ventricular complex burden

BACKGROUND: Data on premature ventricular complex (PVC) burden after pulmonary vein isolation (PVI) for atrial fibrillation (AF) are inconsistent and often limited to selected populations. METHODS: We retrospectively analyzed patients undergoing successful first-time PVI for paroxysmal or persistent AF between January 2019 and June 2023. PVC burden was quantified by long-term ECG at baseline, 3 months, and 12 months. Ablation energy sources included cryoballoon, radiofrequency, and pulsed field ablation. RESULTS: Among 1,069 patients, median PVC burden decreased from 6.82/h at baseline to 1.44/h at 3 months and 3.75/h at 12 months. In patients with complete follow-up (n = 165), PVC burden declined significantly overall (Friedman test p < 0.001). Post-hoc analyses confirmed reductions from baseline to 3 and 12 months, with a modest increase between 3 and 12 months (all p < 0.01). PVC burden was similar regardless of AF recurrence or ablation energy. At 12 months, 4.6% of patients had high PVC burden (> 5%). Diabetes mellitus (OR = 4.43; 95% CI: 1.49-13.17; p = 0.007) and reduced left ventricular ejection fraction (OR = 6.36; 95% CI: 2.03-19.91; p = 0.002) were independently associated with elevated burden, while other covariates were not significant. CONCLUSION: PVI significantly reduces PVC burden in most patients, independent of AF recurrence or ablation modality. Diabetes and impaired ventricular function identify patients at risk of persistent high PVC burden. PVI may particularly benefit AF patients with symptomatic PVCs, but larger prospective studies are needed to validate these findings and assess clinical outcomes.