Angiotensin receptor-neprilysin inhibitor therapy and recurrence of atrial fibrillation after radiofrequency catheter ablation: A propensity-matched cohort study

Abstract

BackgroundCompared with conventional medicines, angiotensin receptor-neprilysin inhibitor (ARNI) could further improve the prognosis for multiple cardiovascular diseases, such as heart failure, hypertension, and myocardial infarction. However, the relationship between ARNI therapy and the recurrence of atrial fibrillation (AF) after radiofrequency catheter ablation is currently unknown.MethodsThis study is a retrospective cohort study. Patients with consecutive persistent or paroxysmal AF undergoing first-time radiofrequency ablation were enrolled from February 2018 to October 2021. We compared the risk of AF recurrence in patients with catheter ablation who received ARNI with the risk of AF recurrence in those who received the angiotensin-converting enzyme inhibitor (ACEI). The propensity-score matched analysis was conducted to examine the effectiveness of ARNI. We used a Cox regression model to evaluate AF recurrence events.ResultsAmong 679 eligible patients, 155 patients with ARNI treatment and 155 patients with ACEI treatment were included in the analyses. At a median follow-up of 228 (196–322) days, ARNI as compared with ACEI was associated with a lower risk of AF recurrence [adjusted hazard ratio (HR), 0.39; 95% confidence interval (CI), 0.24–0.63; p < 0.001]. In addition, no interaction was found in the subgroup analysis.ConclusionAngiotensin receptor-neprilysin inhibitor treatment was associated with a decreased risk of AF recurrence after first-time radiofrequency catheter ablation.

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

“…A total of 2739 articles were obtained after the initial screening. After eliminating duplicate articles, 22 articles 7,11–31 were finally included according to the inclusion and exclusion criteria. The literature screening process and results are shown in the Supplemental Digital Content 1 ( PRISMA flow chart , http://links.lww.com/JCVP/B10).…”

“…Among the included studies, 3 articles [11][12][13] reported the effect of ARNI compared with RASIs on AF recurrence, showing a significant statistical difference (P , 0.00001; Fig. 4).…”

Effect of angiotensin receptor-neprilysin inhibitor on atrial electrical instability in atrial fibrillation

“…Several studies suggested that ARNI could decrease the atrial remodeling in heart failure and play a potential role in AF prevention ( 14 ). Dong et al found ARNI was associated with a lower risk of AF recurrence compared to ACEI after RFCA in a propensity-matched cohort study ( 15 ). However, it was difficult to find whether it was the ARB or ARNI as a whole that resulted in a superior therapeutic effect to ACEI after the RFCA, given that ARB was one of the components of ARNI.…”