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

Q: What are the key findings of this study?

ARNI significantly reduced the recurrence of atrial fibrillation at 12 months post-ablation compared to ACEI/ARB or no treatment (RR 0.65).

Q: What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Atrial fibrillation post-radiofrequency catheter ablation (n=1476). Intervention: Angiotensin receptor-neprilysin inhibitor (ARNI) vs. ACEI/ARB or Blank (no treatment). Primary outcome: Atrial fibrillation recurrence at 12 months (RCTs) (RR 0.65, 95% CI 0.49-0.88, p=0.005).

Q: What does this research mean for the field?

Angiotensin receptor-neprilysin inhibitors are more effective than ACE inhibitors or ARBs in preventing atrial fibrillation recurrence after ablation in Asian populations. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

Yangyang Wang; Wenjing Zhang; Yang Shao; Qiming Dong; Yunfei Gu; Hao Wang

doi:10.1002/clc.70284

April 1, 2026Clinical CardiologyOpen Access

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

View Full Paper

Ask AI

Bookmark

Share

Key result

ARNI reduces post-ablation atrial fibrillation recurrence ~35% at 12 months vs ACEI/ARB or control.

RR 0.65
95% CI 0.49-0.88
P=0.005
n=1,476

Figures

Graphical abstract published by Clinical Cardiology — Graphical abstract · Published by Clinical Cardiology · CC BY

Why the study?

The efficacy of angiotensin receptor-neprilysin inhibitor (ARNI) in reducing atrial fibrillation recurrence risk after ablation remains uncertain.

Does ARNI reduce atrial fibrillation recurrence in patients undergoing radiofrequency catheter ablation?

Key Points

To assess the efficacy of angiotensin receptor-neprilysin inhibitors (ARNI) versus ACEI/ARB or no treatment in preventing atrial fibrillation recurrence following radiofrequency catheter ablation.
Conducted a systematic review and meta-analysis (PROSPERO registered) of 11 studies in Asian populations (7 RCTs and 4 cohort studies; total N=1476: 740 receiving ARNI, 566 receiving ACEI/ARB, and 170 blank controls).
Merged effect sizes using fixed effects models stratified by study type (RCT vs cohort), follow-up intervals (3, 6, and 12 months), and control comparison (ACEI/ARB vs blank).
In RCTs, ARNI significantly reduced AF recurrence at 3 months (12.9% vs 23.1%; RR = 0.56; 95% CI = 0.37-0.85; p = 0.006), 6 months (16.8% vs 29.7%; RR = 0.57; 95% CI = 0.39-0.82; p = 0.003), and 12 months (23.4% vs 35.8%; RR = 0.65; 95% CI = 0.49-0.88; p = 0.005).
In cohort studies at 6 months, ARNI therapy yielded a significantly lower recurrence rate than controls (16.0% vs 36.3%; RR = 0.44; 95% CI = 0.32-0.61; p < 0.001).
Subgroup analyses showed ARNI reduced recurrence compared to ACEI/ARB controls in both RCTs (RR = 0.55; 95% CI = 0.39-0.77; p < 0.001) and cohort studies (RR = 0.46; 95% CI = 0.35-0.61; p < 0.001), as well as compared to blank controls in RCTs (RR = 0.61; 95% CI = 0.42-0.88; p = 0.008).

Study Design

Type

Meta-Analysis (n=1,476)

Structured PICO

Does ARNI reduce atrial fibrillation recurrence in patients undergoing radiofrequency catheter ablation?

P

Population

1,476 patients with atrial fibrillation undergoing radiofrequency catheter ablation across 11 studies in China, followed for 3 to 12 months.

I

Intervention

Angiotensin receptor-neprilysin inhibitor (ARNI) for 3 to 12 months

C

Comparator

Angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB) or Blank (no treatment)

O

Outcome

Atrial fibrillation recurrence after ablation at 3, 6, and 12 monthshard clinical

Main Result

Relative Risk: 0.65 (95% CI 0.49–0.88)

Absolute Event Rate: 23.4% vs 35.8%

p-value: p=0.005

ARNI therapy post-ablation offers a promising strategy to maintain sinus rhythm and reduce AF recurrence compared to standard ACEI/ARB therapy.

Limitations

Small sample size
Indirectness of results due to absence of individual patient data
Inability to perform subgroup analyses based on dosage or HF subtype
Lack of intracavitary mapping data
All trials conducted in China
Unable to perform subgroup analyses based on dosage or HF subtype

Implication

ARNI may reduce post-ablation AF recurrence; extends limited RCT and cohort data but remains hypothesis-generating pending larger trials.

Abstract

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.

Discussion

No takes yet. Share an insight, caveat, or question.

Cite This Study

Wang et al. (2026) conducted a meta-analysis in Atrial fibrillation post-radiofrequency catheter ablation (n=1,476). Angiotensin receptor-neprilysin inhibitor (ARNI) vs. ACEI/ARB or Blank (no treatment) was evaluated on Atrial fibrillation recurrence at 12 months (RCTs) (RR 0.65, 95% CI 0.49-0.88, p=0.005). ARNI significantly reduced the recurrence of atrial fibrillation at 12 months post-ablation compared to ACEI/ARB or no treatment (RR 0.65).

synapsesocial.com/papers/69d5f11e74eaea4b11a7aaa4 https://doi.org/10.1002/clc.70284

Topics

Atrial fibrillation

Persistent AF management

AF ablation outcomes

Anticoagulation in AF

View Full Paper

Ask AI

Bookmark

Share

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

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Topics

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

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Keep reading

More related papers

More on Atrial fibrillation

More from Clinical Cardiology

Topics

Keep reading

More related papers

More on Atrial fibrillation

More from Clinical Cardiology