Impact of additional left atrial roof ablation for persistent atrial fibrillation using cryoballoon: the ICEBERG...

Several studies have investigated the efficacy of additional left atrial (LA) roof ablation to pulmonary vein isolation (PVI) using cryoballoon for persistent atrial fibrillation (AF). However, the evidence from randomized controlled trials regarding adjunctive LA roof ablation with cryoballoon remains unclear.

This study aimed to prospectively evaluate the efficacy and safety of adding LA roof ablation to PVI using cryoballoon in patients with persistent AF.

A total of 106 patients with persistent AF who underwent an initial catheter ablation using cryoballoon were randomly assigned in a 1:1 ratio to either PVI plus LA roof ablation (53 patients) or PVI alone (53 patients). The primary outcome was freedom from recurrence of atrial tachyarrhythmia lasting ≥ 30 s at 12 months after a single ablation procedure. The secondary outcome was procedure-related complications.

No significant differences were observed in baseline characteristics between the PVI-plus group and the PVI-alone group. PVI was successfully performed in all patients. In the PVI-plus group, LA roof ablation was completed successfully in all cases. There was no significant difference in the recurrence-free rate between the two groups (P = 0.071, log-rank test). In addition, no significant differences were observed in procedure-related complications between the two groups.

The addition of LA roof ablation to PVI did not demonstrate superiority to PVI alone in patients with persistent AF undergoing cryoballoon ablation. However, it did not increase the risk of procedure-related complications.