Premature ventricular complexes and risk of atrial fibrillation and stroke in patients without structural heart disease.

Abstract

Prior studies have suggested that patients with premature ventricular complexes (PVCs) may have an increased risk for atrial fibrillation (AF) and stroke. It is unclear whether frequent PVCs are linked to an increased risk of AF and stroke in patients where structural heart disease (SHD) has been excluded. We aimed to study if PVCs increase the risk of AF or stroke in patients without SHD. In this retrospective observational cohort study, we included patients who received a PVC diagnosis at three major hospitals in Stockholm, Sweden. The patients had no history of heart disease, normal results at stress test and echocardiography, and no previous diagnosis of AF or stroke. For each case, four matched controls were obtained from the general population. We used inverse probability weighting (IPW) to control for differences in baseline characteristics. A total of 751 PVC patients and 3041 controls were included. The median age was 59 years, and 2239 (59%) were women. The median follow-up time was 5.2 years. There was a higher risk of AF among patients in the PVC group compared with the control group in the unadjusted analysis (HR 2.08, 95% CI 1.35 to 3.20, p=0.0009). After IPW, there was no significant difference in the risk of AF (HR 1.44, 95% CI 0.88 to 2.37) or stroke (HR 1.32, 95% CI 0.81 to 2.14) between the PVC group and the control group. In patients with PVCs but without SHD, there was no increased risk of AF or stroke compared with controls from the general population after adjusting for known confounders. However, PVCs were associated with AF in the crude cohort, suggesting that PVCs may be a clinical marker for AF.