Real-world outcomes of second-session catheter ablation for idiopathic premature ventricular contractions: insights from the nationwide Japan Catheter Ablation registry

Abstract Background The efficacy and safety of repeated catheter ablation (CA) sessions for idiopathic premature ventricular contractions (PVCs) remain unclear. Objective To evaluate the real-world outcomes of repeated CA sessions for idiopathic PVCs. Methods We analyzed 136 patients (median age: 55 years IQR 43–68; 64 males 47.1%) who underwent second-session CA for idiopathic PVCs originating from the same site as the first session at the same facility, based on data from the Japanese Catheter Ablation Registry collected between August 2017 and December 2020. Results PVC origins included 83 from the right ventricular (RV) outflow tract (RVOT) (45.1%), 15 from other RV (8.2%), 38 from the left ventricular (LV) outflow tract (LVOT) (20.7%), and 48 from other LV (26.1%). Success at discharge was achieved in 108 patients (79.4%), with significantly varying success rates by PVC origin (RVOT: 62/75 82.7%, other RV: 5/8 62.5%, LVOT: 15/23 65.2%, other LV: 26/30 86.7%, P0.01). The recurrence rate before discharge was 5.3% (6/114), with no significant differences across PVC origins. Univariable logistic regression analysis identified female sex as a significant predictor of success at discharge (odds ratio: 2.43 1.02–5.74, P=0.04). However, multivariable logistic regression analysis did not identify any significant predictors, including age, origin, body mass index, or facility experience. Only one patient (0.7%) experienced symptomatic cardiac tamponade as a complication. Conclusion Second-session CA for idiopathic PVCs demonstrated high efficacy comparable to the first session, with a low complication rate.