Background:Atrial fibrillation (AF) recurrence remains a tricky problem in patients undergoing ablation. This meta-analysis aimed to summarize the current literature to clarify whether renin-angiotensin system inhibitors (RASIs) prevent AF recurrence after ablation.

Methods and Results:Relevant studies were searched on Pubmed and EMBASE through December 2019. Pooled relative risk (RR) of AF recurrence was calculated. Subgroup analyses according to study design, race, and follow-up duration were further performed. A total of 15 studies examining 4,300 patients were included, with 3 randomized controlled trials and 12 cohort studies. Overall analysis showed that RASIs significantly reduced AF recurrence after ablation (RR=0.83; 95% confidence interval (CI) 0.70–0.98, P=0.028; I²=68.9%). Subgroup analysis further indicated that positive results were found in randomized controlled trials (RR=0.51, 95% CI 0.37–0.70, P<0.001; I²=4%), studies conducted in Asia (RR=0.59, 95% CI 0.46–0.76, P<0.001; I²=30.7%), and studies with follow-up duration ≥1 year (RR=0.82, 95% CI 0.70–0.95, P=0.01; I²=59.1%); negative results were found in cohort studies, studies conducted in Europe or the USA, and studies with follow-up duration <1 year.

Conclusions:RASIs can potentially prevent AF recurrence after ablation under selected conditions. However, more studies are required to confirm this finding due to the variation in current evidence.

背景：心房颤动（AF）的复发仍然是消融患者的棘手问题。这项荟萃分析旨在总结当前文献，以阐明肾素-血管紧张素系统抑制剂（RASIs）是否能在消融后预防房颤复发。

方法和结果：截至2019年12月，在Pubmed和EMBASE上搜索了相关研究。计算了AF复发的合并相对风险（RR）。根据研究设计，种族和随访时间进行亚组分析。总共包括15项研究，检查了4,300名患者，其中3项随机对照试验和12项队列研究。总体分析显示，RASIs显着降低了消融后的房颤复发（RR = 0.83； 95％置信区间（CI）0.70-0.98，P = 0.028； I ² = 68.9％）。亚组分析进一步表明，在亚洲进行的研究中（RR = 0.59，95％CI 0.46–1.0），在随机对照试验（RR = 0.51，95％CI 0.37–0.70，P <0.001； I ² = 4％）中发现了阳性结果。0.76，P <0.001; I ²= 30.7％），随访时间≥1年的研究（RR = 0.82，95％CI 0.70-0.95，P = 0.01； I ² = 59.1％）；在队列研究，在欧洲或美国进行的研究以及随访时间<1年的研究中发现阴性结果。

结论： RASIs可以在选定条件下潜在地防止消融后房颤复发。然而，由于当前证据的差异，需要更多的研究来证实这一发现。