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Premature ventricular complexes (PVCs) have historically been regarded as benign in individuals without overt structural heart disease (SHD).1 However, accumulating evidence has challenged this paradigm, suggesting a potential role for frequent PVCs in the development of heart failure (HF), atrial fibrillation (AF), stroke and increased mortality.1–5 Current European Society of Cardiology (ESC) guidelines recommend close surveillance of individuals with a PVC burden exceeding 10% (Grade IC).6 Nonetheless, the literature remains replete with conflicting findings, and there is a need for a contemporary systematic review in this field.