Background The prognostic significance of premature atrial complex ( PAC ) burden is not fully elucidated. We aimed to investigate the relationship between the burden of PAC s and long‐term outcome. Methods and Results We investigated the clinical characteristics of 5371 consecutive patients without atrial fibrillation ( AF ) or a permanent pacemaker ( PPM ) at baseline who underwent 24‐hour electrocardiography monitoring between January 1, 2002, and December 31, 2004. Clinical event data were retrieved from the Bureau of National Health Insurance of Taiwan. During a mean follow‐up duration of 10±1 years, there were 1209 deaths, 1166 cardiovascular‐related hospitalizations, 3104 hospitalizations for any reason, 418 cases of new‐onset AF , and 132 PPM implantations. The optimal cut‐off of PAC burden for predicting mortality was 76 beats per day, with a sensitivity of 63.1% and a specificity of 63.5%. In multivariate analysis, a PAC burden >76 beats per day was an independent predictor of mortality (hazard ratio: 1.384, 95% CI : 1.230 to 1.558), cardiovascular hospitalization (hazard ratio: 1.284, 95% CI : 1.137 to 1.451), new‐onset AF (hazard ratio: 1.757, 95% CI : 1.427 to 2.163), and PPM implantation (hazard ratio: 2.821, 95% CI : 1.898 to 4.192). Patients with frequent PAC had increased risk of mortality attributable to myocardial infarction, heart failure, and sudden cardiac death. Frequent PAC s increased risk of PPM implantation owing to sick sinus syndrome, high‐degree atrioventricular block, and/or AF . Conclusions The burden of PAC s is independently associated with mortality, cardiovascular hospitalization, new‐onset AF , and PPM implantation in the long term.