OBJECTIVE: To investigate autonomic involvement in different types of idiopathic premature ventricular contractions (PVCs) grouped by heart rate (HR) dependency. METHODS: One hundred and sixty PVC patients and 31 controls were enrolled. Holter ECG was used to evaluate PVC occurrence, and spectral analysis of heart rate variability (HRV) was calculated to represent cardiac autonomic control. PVCs were divided into fast rate-dependent (F-PVC), slow rate-dependent (S-PVC), and HR-independent PVC (I-PVC) based on the relationship between hourly PVC density and hourly HR. HRV among different types of PVCs were compared, and the association between PVC density with HR and HRV were analyzed. Furthermore, autonomic changes assessed by consecutive 5-min HRV in 30 min before PVC episodes were investigated. RESULTS: In 160 subjects, there were 73 F-PVC, 56 S-PVC, and 31 I-PVC. Hourly PVC density was positively associated with sympathetic indice (LF/HF) and negatively related to vagal indices (HF and HFnu) in F-PVC, and this trend was reversed in S-PVC. During 30 min before PVC onset, RR interval and HFnu decreased significantly with LF/HF showing an increasing trend in F-PVC, while in S-PVC both RR interval and HF increased significantly. It was noted that those changes were most evident during the last 5 min before PVC onset. In addition, PVC density in F-PVC was significantly decreased by beta-blocker treatment. CONCLUSIONS: HR dependency reflected autonomic modulation of idiopathic PVCs. F-PVC and S-PVC might be facilitated by sympathetic activation and vagal activation, respectively. HR dependency and the related autonomic mechanisms should be considered when treating idiopathic PVCs.