Association of Premature Ventricular Contraction with Atrial Fibrillation Ablation Outcomes

Association of Premature Ventricular Contraction with Atrial Fibrillation Ablation Outcomes | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Association of Premature Ventricular Contraction with Atrial Fibrillation Ablation Outcomes Ming Fong Yee, Min Choon Tan, Yong Hao Yeo, Aravinthan Vignarajah, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8653344/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Emerging evidence suggests that premature ventricular contractions (PVCs) may influence atrial electrophysiology and remodeling, potentially leading to higher rates of atrial fibrillation (AF) recurrence. However, existing data is limited to small-scale studies. Therefore, we conducted a retrospective study to evaluate the potential association between PVCs and AF ablation outcomes, which may suggest the need for more aggressive management of ventricular ectopy in this population. Objective This study aims to assess the 5-year outcomes of catheter ablation for AF in patients with and without a diagnosis of PVCs. Methods Using the TriNetX Analytics Research Network, we included patients aged ≥ 18 years who underwent AF catheter between January 1, 2014, and January 1, 2020. Patients were further categorized into two groups based on the presence of a diagnosis of PVCs. Propensity score matching (PSM) was performed using patient demographics, left ventricular ejection fraction (LVEF), cardiac comorbidities, and medications. Study outcomes included all-cause mortality & hospitalization, acute heart failure (HF), and rhythm control interventions during a 5-year follow-up. Results A total of 15,987 patients with PVCs and 40,605 patients without PVCs were identified. After PSM, 15,152 patients from each group were included for further analysis. Compared to control group, patients with PVCs had significantly higher odds of all-cause mortality (odds ratio [OR], 1.138; 95% confidence interval [CI], 1.034–1.253), all-cause hospitalization (OR, 1.300; 95% CI, 1.243–1.360), acute heart failure (HF) (OR, 1.223; 95% CI, 1.162–1.287), and cardiogenic shock (OR, 2.059; 95% CI, 1.751–2.420) following catheter ablation for AF at 5-year follow-up. Additionally, higher odds of AF requiring cardioversion (OR, 1.135; 95% CI, 1.074–1.199) or repeated ablation (OR, 1.164; 95% CI, 1.085–1.249) were observed in the PVCs group. Conclusion Premature ventricular contractions were associated with poorer clinical outcomes and a higher odds of requiring additional rhythm control intervention following catheter ablation for AF. These findings suggest that PVCs may be a marker for worse outcomes after AF ablation. Figures Figure 1 Figure 2 Research Letter Premature ventricular contractions (PVC) are a common arrhythmia that can coexist with atrial fibrillation (AF). While catheter ablation for AF has emerged as the first-line rhythm control strategy 1 , the coexistence of PVC have been linked to a higher risk of developing recurrent AF 2,3 after ablation. 4 However, data addressing the role of PVC in AF ablation outcomes are limited and largely derived from small cohorts, warranting further investigation. Therefore, we conducted this study to examine the 5-year outcomes of catheter ablation for AF in patients with and without PVC. We performed a retrospective cohort study using the TriNetX Analytics Research Network. Patients aged ≥ 18 years who underwent AF catheter ablation between January 1, 2014, and January 1, 2020, were identified using diagnosis and procedure codes. The index date was defined as the date of AF ablation. The population was categorized into two groups based on the presence of PVCs, defined by a diagnosis code or a corresponding laboratory code for ventricular premature depolarization within one year before or after the AF diagnosis. Patients were propensity score matched (1:1) for age, self-identified sex and race, type of AF, hypertension, diabetes mellitus, overweight or obesity, hyperlipidemia, ischemic heart disease, cardiomyopathy, heart failure, ventricular tachycardia, cerebrovascular disease, chronic kidney disease, neoplasm, peripheral vascular disease, chronic obstructive pulmonary disease, anticoagulant use, antiarrhythmic drugs, hemoglobin A1c, and left ventricular ejection fraction. TriNetX uses nearest-neighbor matching with a caliper of 0.1 pooled standard deviations. The study outcomes included 5-year rates of all-cause mortality, all-cause hospitalization, acute heart failure, cardiogenic shock, electrical cardioversion, and repeat AF ablation. Outcomes were assessed from the index date through five years of follow-up. Statistical analysis was performed within the TriNetX platform, with significance set at P < 0.05 (two-sided). Odds ratios (ORs) and confidence intervals (CIs) were calculated using the R survival package version 3.2-3, with proportional hazards assumptions assessed using Schoenfeld residuals. Institutional Review Board approval and informed consent were not required because all data were de-identified. A total of 56,592 patients who underwent AF ablation were identified, including 15,987 patients (28.2%) with concomitant PVCs. Before propensity score matching, patients with PVCs had a higher incidence of heart failure (55.8% vs. 34.5%, p < 0.001) and ischemic heart disease (63.3% vs. 42.7%, p < 0.001) and were older (mean age 69.1 ± 9.7 vs. 66.8 ± 10.2 years, p < 0.001). After propensity matching, 15,152 patients remained in each group for further analysis. Compared with the matched control group, patients with PVCs had significantly higher odds of all-cause mortality (OR 1.138; 95% CI 1.034–1.253), all-cause hospitalization (OR 1.300; 95% CI 1.243–1.360), acute heart failure (OR 1.223; 95% CI 1.162–1.287), and cardiogenic shock (OR 2.059; 95% CI 1.751–2.420) during 5-year follow up. Higher odds of AF requiring cardioversion (OR 1.135; 95% CI 1.074–1.199) and repeat ablation (OR 1.164; 95% CI 1.085–1.249) were also associated with patients with concomitant PVCs. This study provides observational data on 5-year outcomes of catheter ablation for AF in patients with and without PVCs. Patients with PVCs had higher odds of all-cause mortality, hospitalization, and the need for additional rhythm-control therapy, including cardioversion and repeat ablation. These findings align with prior reports linking PVC to incident AF and recurrent atrial arrhythmias. The observed differences may reflect underlying atrial or ventricular substrate abnormalities or the proarrhythmic effects of persistent ventricular ectopy. 2 , 3 , 5 , 6 Even after matching for left ventricular function, PVCs may serve as a marker of more diffuse myocardial disease, including atrial and ventricular remodeling. Persistent ventricular ectopy may also contribute to ongoing mechanical and hemodynamic stress that promotes continued atrial remodeling and reduces the durability of AF ablation. 7 – 9 Because this was an observational study, causality cannot be established. Prospective studies are needed to validate these findings and determine whether targeted management of ventricular ectopy can improve long-term outcomes after AF ablation. Several limitations should be noted. First, the database lacks information on the true burden of PVCs, which is clinically important because PVCs are common and risk is likely driven by burden rather than mere presence. As a result, we were unable to assess a dose-response relationship or determine whether outcomes were related to the amount of PVCs. Second, reliance on administrative coding may lead to misclassification of PVCs, AF ablation status, comorbidities, or outcomes, and patients coded with PVCs may represent those with more symptomatic or clinically significant ectopy. Third, underreporting of arrhythmic events may underestimate the true prevalence or recurrence of PVCs. Fourth, the database lacks key clinical details, including PVC burden thresholds, morphology, anatomical origin, antiarrhythmic therapy, ablation strategy, and medication adherence, limiting adjustment for confounders. Alternative mechanisms, such as retrograde atrial activation or shared genetic susceptibility, also remain possible but could not be evaluated. The timing of PVC-induced cardiomyopathy is likewise uncertain and unlikely to be captured. Lastly, although proportional hazards assumptions were assessed using Schoenfeld residuals, potential violations were not examined in detail, and no sensitivity analyses were performed. In conclusion, our study demonstrates that PVCs are associated with poorer clinical outcomes and a higher likelihood of requiring additional rhythm-control intervention after AF ablation. Although PVCs are not traditionally considered a risk factor for AF, emerging data suggest that patients with higher burden of PVCs may benefit from closer screening and follow-up. Consideration should be given to more aggressive management of PVCs, and this treatment may help optimize the long-term outcomes after AF ablation. Declarations Disclosures: All authors have no relationships relevant to the contents of this paper to disclose. Ethical Approval: The data were deidentified, and Institutional Review Board approval was not required. The study was conducted in accordance with the Declaration of Helsinki. Clinical trial number Not applicable. Corresponding author Min Choon Tan MD Funding: This research received no specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Author Contribution M.F.Y. and M.C.T. conceived and designed the study. M.F.Y., Y.H.Y., and A.V. performed data analysis and interpretation. M.F.Y. drafted the manuscript. O.B., E.H., K.S., H.E.M., and D.S. reviewed and revised the manuscript. All authors reviewed and approved the final manuscript. Data Availability The data used in this study were obtained from the TriNetX Analytics Research Network. Access to the data is available to qualified researchers through the TriNetX platform, subject to institutional approval and data use agreements. The data are de-identified and cannot be publicly shared. References Lacharite-Roberge, A. S. & Hoffmayer, K. S. Premature Ventricular Contractions and Atrial Fibrillation: The Reunion of Distant Relatives? J Am Heart Assoc 12 , e029117, doi:10.1161/JAHA.123.029117 (2023). Kim, Y. G. et al. Premature ventricular contraction is associated with increased risk of atrial fibrillation: a nationwide population-based study. Sci Rep 11 , 1601, doi:10.1038/s41598-021-81229-0 (2021). Lee, P. T. et al. High Burden of Premature Ventricular Complex Increases the Risk of New-Onset Atrial Fibrillation. J Am Heart Assoc 12 , e027674, doi:10.1161/JAHA.122.027674 (2023). Whang, W. et al. Premature Ventricular Complexes After Ablation for Paroxysmal Atrial Fibrillation and Recurrent Atrial Arrhythmias: The admIRE Subanalysis. JACC Clin Electrophysiol 11 , 1738-1746, doi:10.1016/j.jacep.2025.03.035 (2025). Zou, F. et al. Prevalence of atrial fibrillation and procedural outcome in patients undergoing catheter ablation for premature ventricular complexes. J Cardiovasc Electrophysiol 34 , 147-152, doi:10.1111/jce.15749 (2023). Wu, L. et al. New-onset ventricular arrhythmias post radiofrequency catheter ablation for atrial fibrillation. Medicine (Baltimore) 95 , e4648, doi:10.1097/MD.0000000000004648 (2016). Walters, T. E. et al. Left Ventricular Dyssynchrony Predicts the Cardiomyopathy Associated With Premature Ventricular Contractions. J Am Coll Cardiol 72 , 2870-2882, doi:10.1016/j.jacc.2018.09.059 (2018). Tan, A. Y. et al. Persistent Proarrhythmic Neural Remodeling Despite Recovery From Premature Ventricular Contraction-Induced Cardiomyopathy. J Am Coll Cardiol 75 , 1-13, doi:10.1016/j.jacc.2019.10.046 (2020). Cheniti, G. et al. Atrial Fibrillation Mechanisms and Implications for Catheter Ablation. Front Physiol 9 , 1458, doi:10.3389/fphys.2018.01458 (2018). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8653344","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":584335729,"identity":"d8e7f01e-8a65-4f63-a886-7bb82f96ffa7","order_by":0,"name":"Ming Fong Yee","email":"","orcid":"","institution":"Mayo Clinic","correspondingAuthor":false,"prefix":"","firstName":"Ming","middleName":"Fong","lastName":"Yee","suffix":""},{"id":584335730,"identity":"6816ee94-17d2-495f-b860-9b664a00cfb4","order_by":1,"name":"Min Choon 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22:20:41","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8653344/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8653344/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":101880695,"identity":"7964285d-59a8-4d66-a59b-824dfca92aaf","added_by":"auto","created_at":"2026-02-04 15:05:20","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":401328,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eCentral Illustration: Study Design\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8653344/v1/5c3b14e117a35c4bc15b6778.png"},{"id":101792996,"identity":"c6cf7bdd-5331-4bc4-82dd-6d2c78f5cb86","added_by":"auto","created_at":"2026-02-03 16:17:23","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":150426,"visible":true,"origin":"","legend":"\u003cp\u003eIncidence of Five-Year Clinical Outcomes of AF Ablation Patients With PVC Versus Without PVC\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-8653344/v1/244192a77b815b084bc05489.png"},{"id":101943237,"identity":"27212c15-3604-4cd9-9df3-9faf6de031e6","added_by":"auto","created_at":"2026-02-05 09:41:19","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":726143,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8653344/v1/0534f1c2-fe76-4ad3-a1d8-ccf94d5c37c9.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Association of Premature Ventricular Contraction with Atrial Fibrillation Ablation Outcomes","fulltext":[{"header":"Research Letter","content":"\u003cp\u003ePremature ventricular contractions (PVC) are a common arrhythmia that can coexist with atrial fibrillation (AF). While catheter ablation for AF has emerged as the first-line rhythm control strategy\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e, the coexistence of PVC have been linked to a higher risk of developing recurrent AF\u003csup\u003e2,3\u003c/sup\u003e after ablation.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e However, data addressing the role of PVC in AF ablation outcomes are limited and largely derived from small cohorts, warranting further investigation. Therefore, we conducted this study to examine the 5-year outcomes of catheter ablation for AF in patients with and without PVC.\u003c/p\u003e \u003cp\u003eWe performed a retrospective cohort study using the TriNetX Analytics Research Network. Patients aged\u0026thinsp;\u0026ge;\u0026thinsp;18 years who underwent AF catheter ablation between January 1, 2014, and January 1, 2020, were identified using diagnosis and procedure codes. The index date was defined as the date of AF ablation. The population was categorized into two groups based on the presence of PVCs, defined by a diagnosis code or a corresponding laboratory code for ventricular premature depolarization within one year before or after the AF diagnosis. Patients were propensity score matched (1:1) for age, self-identified sex and race, type of AF, hypertension, diabetes mellitus, overweight or obesity, hyperlipidemia, ischemic heart disease, cardiomyopathy, heart failure, ventricular tachycardia, cerebrovascular disease, chronic kidney disease, neoplasm, peripheral vascular disease, chronic obstructive pulmonary disease, anticoagulant use, antiarrhythmic drugs, hemoglobin A1c, and left ventricular ejection fraction. TriNetX uses nearest-neighbor matching with a caliper of 0.1 pooled standard deviations. The study outcomes included 5-year rates of all-cause mortality, all-cause hospitalization, acute heart failure, cardiogenic shock, electrical cardioversion, and repeat AF ablation. Outcomes were assessed from the index date through five years of follow-up. Statistical analysis was performed within the TriNetX platform, with significance set at P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 (two-sided). Odds ratios (ORs) and confidence intervals (CIs) were calculated using the R survival package version 3.2-3, with proportional hazards assumptions assessed using Schoenfeld residuals. Institutional Review Board approval and informed consent were not required because all data were de-identified.\u003c/p\u003e \u003cp\u003eA total of 56,592 patients who underwent AF ablation were identified, including 15,987 patients (28.2%) with concomitant PVCs. Before propensity score matching, patients with PVCs had a higher incidence of heart failure (55.8% vs. 34.5%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and ischemic heart disease (63.3% vs. 42.7%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and were older (mean age 69.1\u0026thinsp;\u0026plusmn;\u0026thinsp;9.7 vs. 66.8\u0026thinsp;\u0026plusmn;\u0026thinsp;10.2 years, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). After propensity matching, 15,152 patients remained in each group for further analysis. Compared with the matched control group, patients with PVCs had significantly higher odds of all-cause mortality (OR 1.138; 95% CI 1.034\u0026ndash;1.253), all-cause hospitalization (OR 1.300; 95% CI 1.243\u0026ndash;1.360), acute heart failure (OR 1.223; 95% CI 1.162\u0026ndash;1.287), and cardiogenic shock (OR 2.059; 95% CI 1.751\u0026ndash;2.420) during 5-year follow up. Higher odds of AF requiring cardioversion (OR 1.135; 95% CI 1.074\u0026ndash;1.199) and repeat ablation (OR 1.164; 95% CI 1.085\u0026ndash;1.249) were also associated with patients with concomitant PVCs.\u003c/p\u003e \u003cp\u003eThis study provides observational data on 5-year outcomes of catheter ablation for AF in patients with and without PVCs. Patients with PVCs had higher odds of all-cause mortality, hospitalization, and the need for additional rhythm-control therapy, including cardioversion and repeat ablation. These findings align with prior reports linking PVC to incident AF and recurrent atrial arrhythmias. The observed differences may reflect underlying atrial or ventricular substrate abnormalities or the proarrhythmic effects of persistent ventricular ectopy.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e Even after matching for left ventricular function, PVCs may serve as a marker of more diffuse myocardial disease, including atrial and ventricular remodeling. Persistent ventricular ectopy may also contribute to ongoing mechanical and hemodynamic stress that promotes continued atrial remodeling and reduces the durability of AF ablation.\u003csup\u003e\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e Because this was an observational study, causality cannot be established. Prospective studies are needed to validate these findings and determine whether targeted management of ventricular ectopy can improve long-term outcomes after AF ablation.\u003c/p\u003e \u003cp\u003eSeveral limitations should be noted. First, the database lacks information on the true burden of PVCs, which is clinically important because PVCs are common and risk is likely driven by burden rather than mere presence. As a result, we were unable to assess a dose-response relationship or determine whether outcomes were related to the amount of PVCs. Second, reliance on administrative coding may lead to misclassification of PVCs, AF ablation status, comorbidities, or outcomes, and patients coded with PVCs may represent those with more symptomatic or clinically significant ectopy. Third, underreporting of arrhythmic events may underestimate the true prevalence or recurrence of PVCs. Fourth, the database lacks key clinical details, including PVC burden thresholds, morphology, anatomical origin, antiarrhythmic therapy, ablation strategy, and medication adherence, limiting adjustment for confounders. Alternative mechanisms, such as retrograde atrial activation or shared genetic susceptibility, also remain possible but could not be evaluated. The timing of PVC-induced cardiomyopathy is likewise uncertain and unlikely to be captured. Lastly, although proportional hazards assumptions were assessed using Schoenfeld residuals, potential violations were not examined in detail, and no sensitivity analyses were performed.\u003c/p\u003e \u003cp\u003eIn conclusion, our study demonstrates that PVCs are associated with poorer clinical outcomes and a higher likelihood of requiring additional rhythm-control intervention after AF ablation. Although PVCs are not traditionally considered a risk factor for AF, emerging data suggest that patients with higher burden of PVCs may benefit from closer screening and follow-up. Consideration should be given to more aggressive management of PVCs, and this treatment may help optimize the long-term outcomes after AF ablation.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eDisclosures:\u003c/h2\u003e\n\u003cp\u003eAll authors have no relationships relevant to the contents of this paper to disclose.\u003c/p\u003e\n\u003ch2\u003eEthical Approval:\u003c/h2\u003e\n\u003cp\u003eThe data were deidentified, and Institutional Review Board approval was not required. The study was conducted in accordance with the Declaration of Helsinki.\u003c/p\u003e\n\u003ch2\u003eClinical trial number\u003c/h2\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003ch2\u003eCorresponding author\u003c/h2\u003e\n\u003cp\u003eMin Choon Tan MD\u003c/p\u003e\n\u003ch2\u003eFunding:\u003c/h2\u003e\n\u003cp\u003eThis research received no specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eM.F.Y. and M.C.T. conceived and designed the study. M.F.Y., Y.H.Y., and A.V. performed data analysis and interpretation. M.F.Y. drafted the manuscript. O.B., E.H., K.S., H.E.M., and D.S. reviewed and revised the manuscript. All authors reviewed and approved the final manuscript.\u003c/p\u003e\n\u003ch2\u003eData Availability\u003c/h2\u003e\n\u003cp\u003eThe data used in this study were obtained from the TriNetX Analytics Research Network. Access to the data is available to qualified researchers through the TriNetX platform, subject to institutional approval and data use agreements. The data are de-identified and cannot be publicly shared.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eLacharite-Roberge, A. S. \u0026amp; Hoffmayer, K. S. Premature Ventricular Contractions and Atrial Fibrillation: The Reunion of Distant Relatives? \u003cem\u003eJ Am Heart Assoc\u003c/em\u003e \u003cstrong\u003e12\u003c/strong\u003e, e029117, doi:10.1161/JAHA.123.029117 (2023).\u003c/li\u003e\n\u003cli\u003eKim, Y. G.\u003cem\u003e et al.\u003c/em\u003e Premature ventricular contraction is associated with increased risk of atrial fibrillation: a nationwide population-based study. \u003cem\u003eSci Rep\u003c/em\u003e \u003cstrong\u003e11\u003c/strong\u003e, 1601, doi:10.1038/s41598-021-81229-0 (2021).\u003c/li\u003e\n\u003cli\u003eLee, P. T.\u003cem\u003e et al.\u003c/em\u003e High Burden of Premature Ventricular Complex Increases the Risk of New-Onset Atrial Fibrillation. \u003cem\u003eJ Am Heart Assoc\u003c/em\u003e \u003cstrong\u003e12\u003c/strong\u003e, e027674, doi:10.1161/JAHA.122.027674 (2023).\u003c/li\u003e\n\u003cli\u003eWhang, W.\u003cem\u003e et al.\u003c/em\u003e Premature Ventricular Complexes After Ablation for Paroxysmal Atrial Fibrillation and Recurrent Atrial Arrhythmias: The admIRE Subanalysis. \u003cem\u003eJACC Clin Electrophysiol\u003c/em\u003e \u003cstrong\u003e11\u003c/strong\u003e, 1738-1746, doi:10.1016/j.jacep.2025.03.035 (2025).\u003c/li\u003e\n\u003cli\u003eZou, F.\u003cem\u003e et al.\u003c/em\u003e Prevalence of atrial fibrillation and procedural outcome in patients undergoing catheter ablation for premature ventricular complexes. \u003cem\u003eJ Cardiovasc Electrophysiol\u003c/em\u003e \u003cstrong\u003e34\u003c/strong\u003e, 147-152, doi:10.1111/jce.15749 (2023).\u003c/li\u003e\n\u003cli\u003eWu, L.\u003cem\u003e et al.\u003c/em\u003e New-onset ventricular arrhythmias post radiofrequency catheter ablation for atrial fibrillation. \u003cem\u003eMedicine (Baltimore)\u003c/em\u003e \u003cstrong\u003e95\u003c/strong\u003e, e4648, doi:10.1097/MD.0000000000004648 (2016).\u003c/li\u003e\n\u003cli\u003eWalters, T. E.\u003cem\u003e et al.\u003c/em\u003e Left Ventricular Dyssynchrony Predicts the Cardiomyopathy Associated With Premature Ventricular Contractions. \u003cem\u003eJ Am Coll Cardiol\u003c/em\u003e \u003cstrong\u003e72\u003c/strong\u003e, 2870-2882, doi:10.1016/j.jacc.2018.09.059 (2018).\u003c/li\u003e\n\u003cli\u003eTan, A. Y.\u003cem\u003e et al.\u003c/em\u003e Persistent Proarrhythmic Neural Remodeling Despite Recovery From Premature Ventricular Contraction-Induced Cardiomyopathy. \u003cem\u003eJ Am Coll Cardiol\u003c/em\u003e \u003cstrong\u003e75\u003c/strong\u003e, 1-13, doi:10.1016/j.jacc.2019.10.046 (2020).\u003c/li\u003e\n\u003cli\u003eCheniti, G.\u003cem\u003e et al.\u003c/em\u003e Atrial Fibrillation Mechanisms and Implications for Catheter Ablation. \u003cem\u003eFront Physiol\u003c/em\u003e \u003cstrong\u003e9\u003c/strong\u003e, 1458, doi:10.3389/fphys.2018.01458 (2018).\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-8653344/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8653344/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEmerging evidence suggests that premature ventricular contractions (PVCs) may influence atrial electrophysiology and remodeling, potentially leading to higher rates of atrial fibrillation (AF) recurrence. However, existing data is limited to small-scale studies. Therefore, we conducted a retrospective study to evaluate the potential association between PVCs and AF ablation outcomes, which may suggest the need for more aggressive management of ventricular ectopy in this population.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study aims to assess the 5-year outcomes of catheter ablation for AF in patients with and without a diagnosis of PVCs.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eUsing the TriNetX Analytics Research Network, we included patients aged ≥ 18 years who underwent AF catheter between January 1, 2014, and January 1, 2020. Patients were further categorized into two groups based on the presence of a diagnosis of PVCs. Propensity score matching (PSM) was performed using patient demographics, left ventricular ejection fraction (LVEF), cardiac comorbidities, and medications. Study outcomes included all-cause mortality \u0026amp; hospitalization, acute heart failure (HF), and rhythm control interventions during a 5-year follow-up.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 15,987 patients with PVCs and 40,605 patients without PVCs were identified. After PSM, 15,152 patients from each group were included for further analysis. Compared to control group, patients with PVCs had significantly higher odds of all-cause mortality (odds ratio [OR], 1.138; 95% confidence interval [CI], 1.034–1.253), all-cause hospitalization (OR, 1.300; 95% CI, 1.243–1.360), acute heart failure (HF) (OR, 1.223; 95% CI, 1.162–1.287), and cardiogenic shock (OR, 2.059; 95% CI, 1.751–2.420) following catheter ablation for AF at 5-year follow-up. Additionally, higher odds of AF requiring cardioversion (OR, 1.135; 95% CI, 1.074–1.199) or repeated ablation (OR, 1.164; 95% CI, 1.085–1.249) were observed in the PVCs group.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePremature ventricular contractions were associated with poorer clinical outcomes and a higher odds of requiring additional rhythm control intervention following catheter ablation for AF. These findings suggest that PVCs may be a marker for worse outcomes after AF ablation.\u003c/p\u003e","manuscriptTitle":"Association of Premature Ventricular Contraction with Atrial Fibrillation Ablation Outcomes","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-03 16:17:14","doi":"10.21203/rs.3.rs-8653344/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"32391eb3-9ab9-4de6-925e-95d7151a1ae7","owner":[],"postedDate":"February 3rd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-03T16:17:14+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-03 16:17:14","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8653344","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8653344","identity":"rs-8653344","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}