Efficacy and safety of catheter ablation for idiopathic premature ventricular contraction in Japan: from the nationwide Japan Catheter Ablation Registry

Abstract Introduction Catheter ablation (CA) is a viable approach for managing frequent idiopathic premature ventricular contractions (PVCs) associated with PVC-related cardiomyopathy. However, the real-world outcomes and appropriate indications for CA need further clarification. Methods This is the first nationwide analysis focusing on the efficacy and safety of CA of idiopathic PVCs. We analyzed 6,751 patients (age 58 [45-70], 3,265 males [48.4%]) who underwent their first CA for idiopathic PVCs with a single origin (3,849 right ventricular [RV] outflow tract [OT], 614 other RV, 1,517 in left ventricular [LV]-OT, and 771 in other LV), based on the Japanese Catheter Ablation Registry between August 2017 and December 2020. Results Success at discharge (SAD) was achieved in 5,276 (78.1%) patients, while 238 patients experienced recurrence before discharge (4.3% of those with acute success). SAD was achieved in 3,236/3,849 (84.1%) RVOT, 379/614 (61.7%) other RV, 1,145/1,517 (75.5%) LVOT, and 516/771 (66.9%) other LV patients (P <0.001). Age <50 and females were independent predictors for SAD. Conversely, obesity, origins other than RVOT, and low-volume facilities were independently inversely related to SAD. 171 (2.5%) acute complications, including 125 cardiac tamponades (CTs) (1.9%), were reported. Age ≥60 and females were independent predictors for both total complications and CTs. Remarkably, females aged ≥80 with RVOT origins exhibited a 10.3% rate of CTs. Conclusion Female patients aged <50 with OT-PVC without obesity, demonstrated favorable efficacy. However, non-OT PVCs were independently inversely related to SAD. Special attention should be given to females aged ≥60 with RVOT origins.