Efficacy and safety of Wenxin Keli for ventricular premature beat: An overview of systematic reviews and meta-analyses

Background: Wenxin Keli (WXKL) is a common medication used to treat ventricular premature beat (VPB). As a complementary alternative therapy, the clinical efficacy and safety of WXKL-assisted treatment of VPB has been reported by several systematic reviews (SRs), but the quality of evidence has not been systematically reviewed. Methods: We conducted a literature search on 7 databases until May 1, 2025. Risk of bias in systematic was used to assess the risk of bias in SRs. A measurement tool to Assess Systematic Reviews 2 was used to evaluate the methodological quality of the SRs, respectively. Grading of recommendations assessment, development and evaluation (GRADE) was used to evaluate the quality grading of outcomes. Results: Eleven SRs, including 211 clinical randomized controlled trials and 19,673 patients, met the inclusion criteria. Four SRs (36.36%) were rated as low risk and 7 SRs (63.64%) were rated as high risk. Only 3 SRs had low methodological quality, while the remaining 8 SRs had critically low methodological quality. We evaluated 46 outcomes, with moderate quality evidence in 6 (13.04%), low-quality evidence in 24 (52.17%), very low-quality evidence in 16 (34.78%). The pooled results suggest that WXKL appears to have an advantage in improving 24-hour Holter electrocardiogram and clinical symptoms in VPB, but the overall efficacy in VPB should be interpreted with caution. Meta-analysis showed that WXKL combined with conventional western medications improved the total effective rate (Relative risk [RR] = 1.08, 95% confidence interval [CI]: 1.06–1.11, P < .00001), the effect of 24-hour Holter electrocardiogram (RR = 1.22, 95% CI: 1.17–1.27, P < .00001) and clinical symptoms (RR = 3.00, 95% CI: 2.17–4.27, P < .00001). There were no significant differences in adverse effects (RR = 0.85, 95% CI: 0.68–1.06, P = .16). Conclusion: WXKL adjuvant therapy of VPB may be effective, but the evidence quality is low. Physicians should choose carefully in the context of the clinical situation when referring to SRs of WXKL for the treatment of VPB for clinical decision making.