Premature ventricular complex characteristics in atrial fibrillation patients without structural heart disease

Background Premature ventricular complexes (PVCs) are common arrhythmias frequently observed in patients with atrial fibrillation (AF), yet their pathophysiological relationship remains complex and bidirectional. It is unclear whether PVCs arise secondary to structural and electrophysiological remodeling associated with AF or represent an independent arrhythmogenic trigger contributing to AF development. This study aimed to evaluate the frequency, burden, and morphological characteristics of PVCs in patients with AF, determine their anatomical origin, and investigate their association with clinical variables, laboratory markers, and echocardiographic parameters. Methods This study included 103 consecutive patients diagnosed with AF who underwent 24-hour, 12-lead ambulatory electrocardiographic monitoring at the Department of Cardiology. Patients with ischemic heart disease, structural heart disease, or Ashman aberrancy were excluded. Demographic characteristics, comorbidities, laboratory findings, echocardiographic measurements, PVC burden, and PVC anatomical origins were compared between patients with and without PVCs. Results PVCs were detected in 75 patients (72.8%). Patients with PVCs were older (p=0.002) and had a higher prevalence of chronic kidney disease (p=0.013) and diabetes mellitus (p=0.027). CHADS-VA scores and NYHA functional class were significantly higher in the PVC group (p=0.001 for both). NT-proBNP positivity was more frequent (72.0% vs. 35.7%; p<0.001) and median NT-proBNP values were significantly greater in patients with PVCs (1120 pg/mL vs. 259 pg/mL; p<0.001). Echocardiographically, lateral e’ velocity was lower and mean E/e’ ratio was higher in the PVC group (p=0.01). Left atrial volume index (LAVI) was elevated in 55.3% of all patients, 78% of whom had PVCs. Multifocal PVCs were observed in 44% of patients, and non-sustained ventricular tachycardia (NSVT) was recorded in 14 cases. Most PVCs originated from the left ventricle (69.3%), predominantly from non-outflow tract regions (41%). In the long-standing persistent AF subgroup, PVCs from the right ventricular outflow tract (RVOT) and non-RVOT right ventricular regions were significantly more frequent (p=0.03). Conclusion PVC prevalence is high in patients with AF and is associated with advanced age, comorbidities, elevated NT-proBNP, and indices of diastolic dysfunction. Unlike the general population, where PVCs predominantly originate from outflow tracts, AF patients in our cohort exhibited a higher proportion of left ventricular and non-outflow tract PVCs. These findings suggest that AF-related structural and hemodynamic remodeling may influence PVC morphology and burden, supporting a potential mechanistic interaction between AF and ventricular ectopy.