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Antiarrhythmic Effect of Sacubitril-Valsartan: Cause or Consequence of Clinical Improvement?

António Valentim Gonçalves1, Tiago Pereira-da-Silva2, Ana Galrinho3

  • 1Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, 1169-024 Lisbon, Portugal. antonio.a.goncalves.14@gmail.com.

Journal of Clinical Medicine
|June 21, 2019
PubMed

Insights

Sacubitril/Valsartan (LCZ696) therapy significantly reduced QTc interval, QRS duration, and mechanical dispersion in heart failure patients. This suggests a potential mechanism for reducing ventricular arrhythmias.

Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Sacubitril/Valsartan (LCZ696) reduced sudden cardiac death in the PARADIGM-HF trial.
  • The mechanism by which LCZ696 reduces ventricular arrhythmias is unclear.

Purpose of the Study:

  • To compare electrocardiographic (ECG) parameters and mechanical dispersion index, assessed by left ventricular (LV) global longitudinal strain (GLS), before and after LCZ696 therapy.

Main Methods:

  • Prospective evaluation of chronic Heart Failure (HF) patients with LV ejection fraction ≤40% receiving LCZ696.
  • ECG and transthoracic echocardiographic data were collected before and at six months of LCZ696 therapy.
  • Mechanical dispersion index was defined as the standard deviation from 16 time intervals of LV GLS.

Main Results:

  • QTc interval (451.9 vs. 426.0 ms, p < 0.001), QRS duration (125.1 vs. 120.8 ms, p = 0.033), and mechanical dispersion index (88.4 vs. 78.1 ms, p = 0.036) were significantly reduced at six months.
  • 35 out of 42 patients completed the six-month follow-up.

Conclusions:

  • LCZ696 therapy is associated with a reduction in QTc interval, QRS duration, and mechanical dispersion index.
  • These findings suggest a potential mechanism for LCZ696's antiarrhythmic effects in heart failure patients.

Keywords:
QRS intervalQTc intervalSacubitril-Valsartanantiarrhythmic effectmechanical dispersion index

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