Sacubitril/Valsartan Can Reduce Atrial Fibrillation Recurrence After Catheter Ablation in Patients with Persistent...

Area of Science:

• Cardiology
• Electrophysiology
• Pharmacology

Background:

• Persistent atrial fibrillation (AF) remains a challenge post-radio-frequency catheter ablation (RFCA).
• Heart failure with preserved ejection fraction (HFpEF) is a common comorbidity influencing AF outcomes.
• Optimizing medical therapy after RFCA is crucial for long-term AF management.

Purpose of the Study:

• To compare the efficacy of sacubitril/valsartan (SV) versus valsartan (V) in preventing AF recurrence after RFCA.
• To evaluate the impact of SV and V on AF burden and patient-reported outcomes.
• To explore the relationship between HFpEF scores and AF recurrence in patients treated with SV or V.

Main Methods:

• A randomized controlled trial involving 143 patients with persistent AF undergoing RFCA.
• Patients were assigned to receive either SV or V for 12 months.
• Primary endpoint: any atrial arrhythmia ≥30s; Secondary endpoint: any atrial arrhythmia ≥24h or requiring cardioversion, post-ablation blanking period.

Main Results:

• Significantly lower rates of AF recurrence were observed in the SV group compared to the V group for both primary (21.7% vs. 42%, P<0.001) and secondary endpoints (10.1% vs. 37.7%, P<0.001).
• A decrease in the H2FPEF score after 1 year was strongly associated with reduced AF recurrence (OR, 0.065; P<0.001).
• The study demonstrated a marked reduction in AF recurrence with SV treatment.

Conclusions:

• Sacubitril/valsartan (SV) is more effective than valsartan (V) alone in reducing AF recurrence after RFCA in patients with persistent AF.
• The therapeutic benefit of SV may be partly attributed to its potential to improve HFpEF status, as indicated by H2FPEF score reduction.
• SV represents a promising therapeutic option for managing persistent AF post-ablation, particularly in patients with HFpEF characteristics.