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Background The long-term association between premature ventricular complexes (PVCs) on ventricular structural and functional remodelling has not been well evaluated. The aim of this study was to assess the association between PVC burden and ventricular remodelling in individuals without structural heart disease.Methods This retrospective study analysed patients who underwent Holter monitoring and echocardiography between February 2007 and July 2017 at the Asan Medical Center, Korea. Patients were categorised based on PVC burden: <1%, 1–10% and ≥10%. The primary outcome was a composite of newly developed cardiac structural or functional remodelling, including left ventricular (LV) systolic dysfunction (<40%), severe LV enlargement and moderate-to-severe mitral and tricuspid regurgitations. Each component and all-cause mortality were also assessed.Results A total of 5040 patients with PVCs without structural heart disease were evaluated (mean age 58.8±13.1 years, 47.1% female). Higher PVC burden was associated with younger age, fewer comorbidities and lower baseline LV ejection fraction. The incidence of the primary outcome was significantly higher in the 1%–10% or PVC ≥10% groups compared with the <1% group (at 8 years, 8.7% vs 14.5% vs 14.4% for <1%, 1–10% and ≥10%, respectively; p<0.001). Higher PVC burden also correlated with increased rates of LV dysfunction (2.0%, 4.9%, 7.9%; p=0.009) and enlargement (5.8%, 8.5%, 7.3%; p=0.007).Conclusion A PVC burden >1% was associated with long-term ventricular structural or functional remodelling. Given the dynamic nature of PVC burden, even patients with 1–10% burden may warrant follow-up monitoring, as a single 24-hour Holter may underestimate future risk.