Abstract
BACKGROUND: Atrial fibrillation (AF) is the most common cardiac arrhythmia, associated with significant morbidity, including increased risks of stroke, heart failure, and mortality. While catheter ablation is an effective rhythm control strategy, high recurrence rates postprocedure remain a major clinical challenge. Inflammation plays a key role in AF pathogenesis, and anti-inflammatory therapies have emerged as potential adjunctive treatments to reduce recurrence. This study provides the first network meta-analysis evaluating the efficacy of anti-inflammatory therapies in preventing AF recurrence postablation. METHODS: A systematic review and network meta-analysis were conducted in accordance with PRISMA-NMA guidelines. Randomized controlled trials examining the effects of colchicine, statins, corticosteroids, ACE inhibitors (ACEIs), and ascorbic acid on AF recurrence postablation were included. Direct and indirect comparisons were synthesized, and treatments were ranked using Surface Under the Cumulative Ranking (SUCRA) values. Risk ratios with 95% confidence intervals were calculated, and evidence quality was assessed using the CINeMA tool. RESULTS: The analysis included 13 studies encompassing 21 study arms with 2283 participants. Colchicine and statins demonstrated significant reductions in AF recurrence compared to placebo, with statins achieving the highest SUCRA ranking. Colchicine showed notable efficacy in reducing early recurrence through modulation of inflammatory markers, such as C-reactive protein and interleukin-6. Corticosteroids and ACEIs exhibited nonsignificant effects on recurrence rates, while ascorbic acid demonstrated no benefit. The heterogeneity among included studies was minimal, and sensitivity analyses confirmed the robustness of findings. CONCLUSION: This study represents the first network meta-analysis evaluating anti-inflammatory therapies for AF recurrence prevention postablation. Colchicine and statins emerged as the most promising treatments, particularly during the early postablation period, highlighting their potential role in reducing inflammation and atrial remodeling. Future research should focus on personalized treatment strategies and long-term evaluation of these therapies to improve patient outcomes and reduce AF burden.