Efficacy and Safety of Second Sessions of Catheter Ablation for Idiopathic Premature Ventricular Contractions: From the Nationwide Japan Catheter Ablation Registry

IF 1.7 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Arrhythmia Pub Date : 2025-08-25 DOI:10.1002/joa3.70181

Kentaro Goto, Shinsuke Miyazaki, Reina Tonegawa-Kuji, Koshiro Kanaoka, Seigo Yamashita, Tetsuo Sasano, Yoshitaka Iwanaga, Michikazu Nakai, Koichi Inoue, Yu-Ki Iwasaki, Koichi Nagashima, Kohki Nakamura, Masaharu Masuda, Koji Miyamaoto, Kazuhiro Satomi, Seiji Takatsuki, Kengo Kusano, Teiichi Yamane, Wataru Shimizu

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Abstract

Background

The efficacy and safety of second catheter ablation (CA) sessions for idiopathic premature ventricular contractions (PVCs) from the same origin as the initial session remain unclear.

Methods and Results

We analyzed 138 patients (median age 55 [43–68] years; 74 males [53.6%]) who underwent second CA sessions for idiopathic PVCs from the same origin category, using the Japanese Catheter Ablation Registry data collected between August 2017 and December 2020. PVC origins included 77 from the right ventricular outflow tract (RVOT) (55.8%), 8 from other right ventricular (RV) origins (5.8%), 23 from the left ventricular outflow tract (LVOT) (16.7%), and 30 from other left ventricular (LV) origins (21.7%). Acute success was achieved in 114 patients (82.6%), with significant variations by origins (RVOT: 83.1%, other RV: 75.0%, LVOT: 76.9%, other LV: 90.0%; p < 0.01). In-hospital recurrence despite acute success occurred in 6 patients (5.3%), most frequently in other RV and LVOT sites. Success at discharge cases included more females (57.4% vs. 40.0%; p = 0.04) and were treated at higher-volume centers (median 304 vs. 234 cases/year; p < 0.01). No significant predictors of success at discharge were identified in univariable or multivariable analyses. One patient (0.7%) experienced a cardiac tamponade.

Conclusion

Second CA sessions for idiopathic PVCs are generally safe and effective. However, additional efforts are needed to improve the LVOT and other RV origin efficacy.

Trial Registration: The J-AB registry has been registered in both the UMIN Clinical Trial Registry (UMIN000028288) and ClinicalTrials.gov (NCT03729232).

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第二次导管消融治疗特发性室性早搏的疗效和安全性：来自日本全国导管消融登记

背景：第二次导管消融（CA）治疗原发性室性早搏的有效性和安全性尚不清楚。方法和结果我们分析了138例患者（中位年龄55岁[43-68]岁；74例男性[53.6%]），他们接受了第二次CA治疗，来自同一来源类别的特发性室性心动心动症，使用了2017年8月至2020年12月收集的日本导管消融登记数据。其中右心室流出道（RVOT） 77例（55.8%），其他右心室（RV）源8例（5.8%），左心室流出道（LVOT） 23例（16.7%），其他左心室（LV）源30例（21.7%）。114例患者（82.6%）获得急性成功，不同来源的患者有显著差异（RVOT: 83.1%，其他RV: 75.0%, LVOT: 76.9%，其他LV: 90.0%; p < 0.01）。6例患者（5.3%）出现急性成功后的院内复发，最常见的是其他左心室和左心室部位。出院成功病例中女性患者较多（57.4% vs. 40.0%; p = 0.04），且在容量较大的中心接受治疗（中位304 vs. 234例/年；p < 0.01）。在单变量或多变量分析中没有发现出院成功的显著预测因素。1例（0.7%）出现心脏填塞。结论二次CA治疗特发性室性早搏是安全有效的。然而，需要额外的努力来提高LVOT和其他RV起源的疗效。试验注册：J-AB注册中心已在UMIN临床试验注册中心（UMIN000028288）和ClinicalTrials.gov （NCT03729232）注册。

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