Effect of Post‐Ablational Angiotensin Receptor‐Neprilysin Inhibitor on Atrial Fibrillation Recurrence: A Systematic Review and Meta‐Analysis in Asian Population

BACKGROUND: The efficacy of angiotensin receptor-neprilysin inhibitor (ARNI) in reducing recurrence risk of atrial fibrillation (AF) after ablation remains uncertain. METHODS: We summarized the results about ARNI in preventing AF recurrence after radiofrequency ablation. After PROSPERO registration, two researchers independently screened the literature and assessed the risk of bias in the included studies. The fixed effects model was used to merge the effect sizes, and the results were reported separately depending on whether the study was a RCT or a cohort study and on the follow-up duration. We further conducted subgroup analysis by comparing the effect of ARNI in reducing AF recurrence to that of angiotensin-converting enzyme inhibitor and/or angiotensin receptor blocker (ACEI/ARB) and to that of the Blank group. Publication bias and sensitivity analysis were evaluated. RESULTS: Both in RCTs and cohort studies, constant usage of ARNI for 6 and 12 months partly reduced the AF recurrence after ablation (using 3-month ARNI in RCTs: RR = 0.56; 95% CI = 0.37-0.85; p = 0.006; using 6-month ARNI in RCTs: RR = 0.57; 95% CI = 0.39-0.82; p = 0.003; using 12-month ARNI in RCTs: RR = 0.65; 95% CI = 0.49-0.88; p = 0.005; using 6-month ARNI in cohort studies: RR = 0.44; 95% CI = 0.32-0.61; p < 0.001). Subgroup analysis showed that, compared to ACEI/ARB or Blank, both in RCTs and cohort studies, ARNI was more effective in reducing the recurrence rate of atrial fibrillation after ablation. CONCLUSIONS: The using of ARNI may be effective in preventing the recurrence of AF after ablation, with ARNIs being shown to be more effective than ACEI/ARBs.