Key result
Treatment with renin-angiotensin system inhibitors significantly reduced the recurrence of atrial fibrillation after catheter ablation compared to control (OR 0.61, 95% CI 0.45-0.82).
Why the study?
Although renin-angiotensin system inhibitors modify arrhythmia substrate and reverse atrial remodeling, their role in atrial fibrillation recurrence after catheter ablation remains controversial.
Do RAS inhibitors reduce the recurrence of atrial fibrillation after catheter ablation?
Meta-Analysis (n=3,661)
Do RAS inhibitors reduce the recurrence of atrial fibrillation after catheter ablation?
Odds Ratio: 0.61 (95% CI 0.45–0.82)
Absolute Event Rate: 27.8% vs 34.8%
This meta-analysis suggests that the use of RAS inhibitors significantly reduces the recurrence rate of atrial fibrillation following catheter ablation.
Supports adjunctive renin-angiotensin system inhibitors after ablation; reinforces meta-analytic evidence for lower recurrence.
Atrial fibrillation (AF) is the most common sustained arrhythmia. Renin-angiotensin system (RAS) inhibitors were reported to modify the arrhythmia substrate and reverse atrial remodeling. However, the role of RAS inhibitors on AF recurrence after catheter ablation remains much more controversial. In this study, a meta-analysis was performed to explore the effect of RAS inhibitors on AF recurrence after catheter ablation.We searched PubMed, Cochrane Library, EMBASE, and Web of Science for all articles published up to July 2019 on the effect of RAS inhibitors on AF recurrence rate after ablation. We used the random-effects model to estimate the odds ratios (ORs) and confidence intervals (CI). The I2 statistic was used to evaluate statistical heterogeneity. A two-tailed P value of <0.05 was considered statistically significant. Results were further analyzed by subgroup according to the type of study design.We included 13 studies, including 3661 patients with AF, in this analysis, of which 4 were randomized controlled trials (RCTs) and the others were cohort studies. Overall, treatment with RAS inhibitors showed a significant reduction of AF recurrence after catheter ablation (OR, 0.61; 95% CI, 0.45-0.82). Additionally, both the RCT (OR, 0.35; 95% CI, 0.24-0.49) and non-RCT (OR, 0.76; 95% CI, 0.57-1.00) groups demonstrated that RAS inhibitors could reduce the AF recurrence rate after catheter ablation in the subgroup analysis.Our meta-analysis suggests that RAS inhibitors had significant benefit in reducing the recurrence rate of AF after catheter ablation.
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Zhao et al. (2020) conducted a meta-analysis in Atrial fibrillation after catheter ablation (n=3,661). Renin-angiotensin system (RAS) inhibitors vs. Control (non-RAS blocker class or placebo) was evaluated on Recurrence of atrial fibrillation after catheter ablation (OR 0.61, 95% CI 0.45-0.82). Treatment with renin-angiotensin system inhibitors significantly reduced the recurrence of atrial fibrillation after catheter ablation compared to control (OR 0.61, 95% CI 0.45-0.82).
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