Clinical implications of intraoperative premature ventricular contractions for 30-day cardiovascular outcomes after liver transplantation

To examine the association between intraoperative premature ventricular contraction (PVC) burden and 30-day major adverse cardiovascular events (MACE) in liver transplantation (LT) recipients, and to determine whether complex ventricular ectopy carries prognostic significance distinct from isolated PVCs. In this retrospective cohort study, continuous intraoperative ECG recordings from 2,290 consecutive LT recipients were analyzed using a validated AI-based detection pipeline. PVCs were classified as isolated or complex (couplet, NSVT, bigeminy, trigeminy), with total complex PVC burden as the primary exposure. Associations with 30-day MACE were estimated by multivariable logistic regression across burden tertiles. Sensitivity analyses used a hard MACE endpoint excluding arrhythmic components and with additional adjustment for isolated PVC burden. MACE occurred in 515 patients (22.5%). PVCs were detected in 98.2% of patients; isolated PVC prevalence did not differ between those with and without MACE (98.4% vs. 98.0%, P = 0.666), whereas complex PVC prevalence was significantly higher in the MACE group (93.2% vs. 85.8%, P < 0.001). Total complex PVC burden showed a graded association with MACE across tertiles (T1 aOR 1.71, 95% CI 1.11-2.65; T2 aOR 2.26, 95% CI 1.47-3.47; T3 aOR 2.79, 95% CI 1.83-4.27), whereas isolated PVC burden was not associated with MACE in any tertile. The association persisted in both sensitivity analyses. Complex intraoperative ventricular ectopy, but not isolated PVCs, was independently associated with 30-day MACE in LT recipients. AI-enabled PVC quantification may identify an intraoperative signal associated with postoperative cardiovascular risk, although prospective and external validation is required before clinical application.