Effect of Post-Ablational Antiarrhythmic Drugs on Atrial Fibrillation Recurrence: A Systematic Review and Meta-Analysis

Background: The efficacy of antiarrhythmic drugs in reducing the risk of recurrence of atrial fibrillation (AF) after ablation is still uncertain. Therefore, we conducted a systematic evaluation on post ablation antiarrhythmic drugs (AADs) to reduce the risk of recurrent atrial fibrillation. Methods: The databases of PubMed, Embase, Web of Science (WOS), China Science and Technology Journal (CSTJ) Database, Wanfang Database, China National Knowledge Infrastructure (CNKI), and China Biology Medicine (CBM) were searched from inception to 31 December 2023. Randomized controlled trials (RCTs) investigating the efficacy of AADs in preventing AF recurrence were included. Statistical analysis was performed using Review Manager 5.3 (Copenhagen: The Nordic Cochrane Centre, The Cochrane collaboration, 2014) and Stata18.0 (Stata, College Station, TX, USA). Results: A total of 16 studies, with 3834 patients were included in the final analysis. The use of AADs was found to reduce early risk of recurrence (<= 3 months) by 28% (risk ratio (RR) = 0.72, 95% confidence interval (CI): 0.53-0.99, p = 0.04), intermediate risk of recurrence (3-12 months) by 22% (RR = 0.78, 95% CI: 0.67-0.91, p = 0.001), and late risk of recurrence (>= 12 months) by 29% (RR = 0.71, 95% CI: 0.47- 1.07, p = 0.1). No published bias was detected. In sensitivity analyses, the result is consistent and stable after removal of either study. Conclusions: The use of AADs after ablation can reduce the recurrence of AF, and the effect can last for at least 6 months in the overall population. In subgroup analysis, this protective effect can even last for 12 months in the Asian region. In addition, AADs should be used for at least 3 months after ablation to achieve this protective effect.