Goto Kentaro, Miyazaki Shinsuke, Tonegawa-Kuji Reina, Kanaoka Koshiro, Yamashita Seigo, Sasano Tetsuo, Iwanaga Yoshitaka, Nakai Michikazu, Inoue Koichi, Iwasaki Yu-Ki, Nagashima Koichi, Nakamura Kohki, Masuda Masaharu, Miyamaoto Koji, Satomi Kazuhiro, Takatsuki Seiji, Kusano Kengo, Yamane Teiichi, Shimizu Wataru
Department of Cardiovascular Medicine Institute of Science Tokyo Tokyo Japan.
Department of Medical and Health Information Management National Cerebral and Cardiovascular Center Osaka Japan.
J Arrhythm. 2025 Aug 25;41(4):e70181. doi: 10.1002/joa3.70181. eCollection 2025 Aug.
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.
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%; < 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%; = 0.04) and were treated at higher-volume centers (median 304 vs. 234 cases/year; < 0.01). No significant predictors of success at discharge were identified in univariable or multivariable analyses. One patient (0.7%) experienced a cardiac tamponade.
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. The J-AB registry has been registered in both the UMIN Clinical Trial Registry (UMIN000028288) and ClinicalTrials.gov (NCT03729232).
针对与首次消融手术起源相同的特发性室性早搏（PVC）进行第二次导管消融（CA）手术的疗效和安全性尚不清楚。
我们使用2017年8月至2020年12月期间收集的日本导管消融登记数据，分析了138例（中位年龄55[43 - 68]岁；74例男性[53.6%]）因同一起源类别的特发性PVC接受第二次CA手术的患者。PVC起源包括右心室流出道（RVOT）77例（55.8%）、其他右心室（RV）起源8例（5.8%）、左心室流出道（LVOT）23例（16.7%）以及其他左心室（LV）起源30例（21.7%）。114例患者（82.6%）获得急性成功，不同起源部位成功率有显著差异（RVOT：83.1%，其他RV：75.0%，LVOT：76.9%，其他LV：90.0%；<0.01）。尽管急性成功但住院期间复发的患者有6例（5.3%），最常见于其他RV和LVOT部位。出院时成功的病例中女性更多（57.4%对40.0%；=0.04），且在手术量大的中心接受治疗（中位每年304例对234例；<0.01）。在单变量或多变量分析中未发现出院时成功的显著预测因素。1例患者（0.7%）发生心脏压塞。
针对特发性PVC进行的第二次CA手术总体安全有效。然而，需要进一步努力提高LVOT和其他RV起源部位的疗效。J - AB登记已在UMIN临床试验登记处（UMIN000028288）和ClinicalTrials.gov（NCT03729232）注册。
