Renin-Angiotensin System Inhibitors for the Prevention of Atrial Fibrillation Recurrence After Ablation　― A Meta-Analysis ―

Abstract

Background: Atrial fibrillation (AF) recurrence remains a tricky problem in patients undergoing ablation. This meta-analysis aimed to summarize the current literature to clarify whether renin-angiotensin system inhibitors (RASIs) prevent AF recurrence after ablation. Methods and Results: Relevant studies were searched on Pubmed and EMBASE through December 2019. Pooled relative risk (RR) of AF recurrence was calculated. Subgroup analyses according to study design, race, and follow-up duration were further performed. A total of 15 studies examining 4,300 patients were included, with 3 randomized controlled trials and 12 cohort studies. Overall analysis showed that RASIs significantly reduced AF recurrence after ablation (RR=0.83; 95% confidence interval (CI) 0.70-0.98, P=0.028; I 2 =68.9%). Subgroup analysis further indicated that positive results were found in randomized controlled trials (RR=0.51, 95% CI 0.37-0.70, P<0.001; I 2 =4%), studies conducted in Asia (RR=0.59, 95% CI 0.46-0.76, P<0.001; I 2 =30.7%), and studies with follow-up duration ≥1 year (RR=0.82, 95% CI 0.70-0.95, P=0.01; I 2 =59.1%); negative results were found in cohort studies, studies conducted in Europe or the USA, and studies with follow-up duration <1 year. Conclusions: RASIs can potentially prevent AF recurrence after ablation under selected conditions. However, more studies are required to confirm this finding due to the variation in current evidence.

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

“…Nineteen studies 7,14–31 reported the effect of RASIs on AF recurrence after ablation. The results showed that the recurrence rate of AF in subjects who received RASIs was lower than that of subjects who did not receive RASIs [RR = 0.85, 95% CI (0.72–0.99), P = 0.03] (Fig.…”

“…Numerous studies have shown that RASIs, including angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB), can prevent left atrial fibrosis and reverse atrial remodeling processes, reducing the occurrence of atrial fibrillation. 2 The world's first angiotensin receptor neprilysin inhibitor (ARNI)-SV, has antihypertensive, vasodilatory, and natriuretic effects and has accumulated much evidence in the treatment of heart failure and hypertension. 3,4 Although the pathophysiology of atrial fibrillation is not yet fully understood, an increasing number of prospective randomized controlled trials (RCTs) have confirmed that atrial fibrillation catheter ablation is superior to drug therapy in maintaining sinus rhythm and significantly improves symptoms and quality of life.…”

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

“…Prior to this study, various studies have explored the effect of drugs on AF recurrence after ablation. One meta-analysis showed that the combined relative risk of AF recurrence in patients with RAAS inhibitors after ablation was 0.83 (95% CI: 0.70–0.98, p = 0.028), however, most studies that fulfill the inclusion criteria did not set a control group ( 47 ). Statins were found to reduce the recurrence of AF in the pooled randomized control trials, but not in all included studies ( 48 ).…”

Bioinformatics Analysis of Competing Endogenous RNA Network and Immune Infiltration in Atrial Fibrillation

“…The atrial electrical and structural remodeling are the core part of AF, and the activation of the renin-angiotensin-aldosterone system (RAAS) contributes to atrial remodeling [ 25 ]. Conversely, studies have demonstrated that renin-angiotensin system inhibitors can delay heart remodeling in patients with AF [ 26 ] and prevent recurrence of AF after ablation [ 27 ]. So, GSEA indicated that those gene sets in AF patients were primarily involved in cardiac muscle, immune, and inflammatory responses.…”