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

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).