A systematic review and meta-analysis of randomized controlled trials on the efficacy of Shensong Yangxin capsule for recurrence of atrial fibrillation after catheter ablation

Ethnopharmacological relevance Shensong Yangxin (SSYX) capsule, a well-known Chinese patent medicine, is widely applied in the treatment of atrial fibrillation (AF). Aim of the study: To determine the efficacy and safety of SSYX as adjunctive therapy on recurrence after ablation in AF patients. Materials and methods A systematic search was conducted across eight databases to identify randomized controlled trials (RCTs) involving SSYX therapy after first AF ablation until 1 st July 2025. The primary outcome was AF recurrence, and safety endpoint was also examined. The quality of evidence was assessed using the GRADE framework. The protocol was prospectively registered on PROSPERO (CRD420251012453). Results Nine studies comprising 2199 patients were included. Anti-arrhythmic drugs (AADs) plus SSYX reduced early recurrence by 45% (RR 0.55, 95% CI: 0.42 to 0.71, P < 0.001; I 2 = 0%) in overall AF populations, and late recurrence by 38% (RR 0.62, 95% CI: 0.47 to 0.81, P < 0.001; I 2 = 0%) in persistent AF. Moreover, no statistically significant difference was observed in the incidence of adverse events between SSYX and control groups. A moderate and low level of evidence were identified for late and early recurrence, separately. Conclusion Combination therapy with AAD and SSYX after ablation could safely and effectively reduce early recurrence across AF populations and late recurrence only for persistent AF. This evidence highlights the potential of SSYX as a potential adjuvant treatment option after AF ablation. However, extrapolation to Western populations requires caution.