An Overview of Systematic Reviews on the Effectiveness of Wenxin Keli in the Treatment of Atrial Fibrillation

BACKGROUND: Atrial fibrillation is one of the most common cardiac arrhythmias. Wenxin Keli (WXKL) is a Chinese herbal extract widely used in China to treat patients with atrial fibrillation. This study aimed to outline and summarize the current evidence of systematic reviews (SRs)/meta-analyses (MAs) investigating the clinical efficacy of WXKL in atrial fibrillation. METHODS: From inception to December 2021, 6 electronic databases in English and Chinese were searched for potential SRs/MAs. The GRADE (Grading of Recommendations Assessment, Development, and Evaluation), PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) checklist, and AMSTAR-2 (Assessing the Methodological Quality of Systematic Reviews-2) were used to evaluate the quality of the evidence, reporting, and methodology of SRs/MAs regarding WXKL for the treatment of atrial fibrillation. RESULTS: A total of 8 SRs/MAs were included in the present study. The results of AMSTAR-2 and PRISMA were unsatisfactory for the main insufficiency founded in registration and protocol, search strategy, excluded study statement, evidence certainty assessment, and funding and conflict of interest information. All the included SRs/MAs were assessed as very low in methodological quality. Moreover, 23 outcomes were evaluated by GRADE for the certainty of evidence, and 2 outcomes were assessed as moderate, while 15 were low and 6 were very low. Risk of bias and publication bias contributed to the downgrading. CONCLUSION: WXKL may be clinically efficacious and safe for the treatment of atrial fibrillation. This finding, however, should be regarded with caution because of the low level of evidence and methodological qualities of the involved SRs/MAs. More standardized, rigorous, and comprehensive SRs/MAs and randomized control trials are needed to provide strong evidence to reach more convincing conclusions.