Impact of origin and frequency of premature ventricular complexes on cardiac remodeling: a systematic review and meta-analysis

Frequent premature ventricular complexes (PVCs) have been associated with adverse cardiac remodeling; however, the relative contributions of PVC frequency and anatomical origin remain unclear. This study evaluated the effects of PVC burden and origin on cardiac structural and functional changes. A systematic review and meta-analysis was conducted in accordance with PRISMA guidelines. PubMed, Embase, CENTRAL, and the Cochrane Library were searched for English-language observational studies published up to December 2025. Studies assessing the relationship between PVC frequency or origin and echocardiographic parameters were included. Frequent PVCs were defined using study-specific thresholds (e.g., > 10,000 beats/day, > 5% of total beats, or > 5000 occurrences per 10 h). Of 625 records, nine studies involving 1886 patients met the inclusion criteria, including six on PVC frequency and three on PVC origin. Pooled analyses were performed using weighted mean differences (WMD) with 95% confidence intervals. Frequent PVCs were significantly associated with reduced left ventricular ejection fraction (LVEF) (WMD = − 3.66, 95% CI − 6.30 to − 1.02; P = 0.007), increased LVEDD (WMD = 3.17, 95% CI 1.35 to 4.99; P = 0.0006), increased LVESD (WMD = 3.27, 95% CI 0.32 to 6.23; P = 0.03), and increased LAD (WMD = 1.59, 95% CI 0.13 to 3.06; P = 0.03), suggesting adverse ventricular and atrial remodeling. PVC origin was not significantly associated with LVEF or LVEDD. A high PVC burden is associated with adverse cardiac remodeling, whereas PVC origin was not significantly associated with structural changes in this analysis and should be interpreted with caution given the limited number of studies and heterogeneity. These findings support the importance of PVC frequency in risk stratification and early intervention.