A Systematic Review and Meta-analysis of Renin-angiotensin Inhibitors and Angiotensin Receptor Neprilysin Inhibitors in Preventing Recurrence after Atrial Fibrillation Ablation

Abstract

To systematically evaluate the efficacy and safety of renin-angiotensin inhibitors (RASIs) and angiotensin receptor neprilysin inhibitors (ARNI) in preventing the recurrence of atrial fibrillation after atrial fibrillation ablation, we have written this meta-analysis. We systematically searched randomized controlled trials or cohort studies on renin-angiotensin inhibitors and angiotensin receptor neprilysin inhibitor—Sacubitril/Valsartan (SV) in preventing the recurrence of atrial fibrillation. Two researchers independently screened the literature, extracted the data, and assessed the risk of bias in the included studies. Afterward, the meta-analysis was performed using RevMan 5.3 software. This meta-analysis results showed that the recurrence rate of atrial fibrillation after ablation in subjects using renin-angiotensin inhibitors (RASIs) was lower than in subjects not using them [RR = 0.85, 95%CI (0.72, 0.99), P = 0.03]; the recurrence rate in subjects using Sacubitril/Valsartan (SV) was lower than in subjects using renin-angiotensin inhibitors (RASIs) [RR= 0.50, 95%CI (0.37, 0.68), P < 0.00001]. These results show that both the use of renin-angiotensin inhibitors (RASIs) and Sacubitril/Valsartan (SV) can prevent the recurrence of after atrial fibrillation ablation, among which the use of Sacubitril/Valsartan (SV) is more effective.