Premature Ventricular Complexes After Ablation for Paroxysmal Atrial Fibrillation and Recurrent Atrial Arrhythmias: The admIRE Subanalysis.

Background: Premature ventricular complexes (PVCs) have been reported to independently predict incident atrial fibrillation in the general population. The prognostic importance of PVCs after catheter ablation for paroxysmal atrial fibrillation (PAF) is unknown.

Objectives: In patients undergoing catheter ablation for PAF, we assessed whether postablation PVCs influence the risk for recurrence.

Methods: We analyzed data from admIRE (Assessment of Safety and Effectiveness in Treatment Management of Atrial Fibrillation With the Biosense-Webster Irreversible Electroporation Ablation System; NCT05293639), a multicenter single-arm Food and Drug Administration trial of PAF patients undergoing pulsed field ablation with a variable-loop catheter. Transtelephonic monitoring ≥60 seconds was collected weekly during months 1 to 5, monthly during months 6 to 12, and for symptomatic events, and PVCs were assessed by a core lab. Logistic regression models of the relationship between early postablation PVCs (days 1-180) and postblanking (days 91-365) recurrence of atrial arrhythmia were fitted.

Results: Among 361 patients from admIRE, 135 (37.5%) patients had postablation PVCs noted prior to day 180. In the multivariable model, as compared with patients without postablation PVCs, those with PVCs had double the risk of atrial arrhythmia recurrence (OR: 2.1; 95% CI: 1.2-3.5; P = 0.006). An additional analysis in a second study that used very high-power, short-duration radiofrequency ablation for PAF demonstrated in a smaller cohort (N = 261), early PVCs were again associated with higher risk of recurrence (OR: 2.3; 95% CI: 1.2-4.6; P = 0.015).

Conclusions: Patients with PVCs in the first 6 months after catheter ablation for PAF are at higher risk for recurrent atrial arrhythmia. Whether PVCs themselves trigger atrial arrhythmias, or common underlying mechanisms trigger both, remains uncertain.