Sacubitril/valsartan: An antiarrhythmic drug?
Elaine Huang1, Michael L Bernard2, A Elise Hiltbold2
1Department of Internal Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA.
Insights
The combined angiotensin receptor and neprilysin inhibitor (ARNi) may reduce sudden cardiac death (SCD) in heart failure (HF) patients. This review explores ARNi
Area of Science:
- Cardiology
- Pharmacology
- Heart Failure Research
Background:
- Heart failure (HF) significantly contributes to morbidity and mortality.
- Sudden cardiac death (SCD), often due to arrhythmias, accounts for nearly half of HF deaths.
- Hemodynamic stress in HF can increase arrhythmogenesis, creating a substrate for SCD.
Purpose of the Study:
- To review and synthesize current literature on the effects of sacubitril/valsartan (an angiotensin receptor and neprilysin inhibitor - ARNi) on cardiac rhythm.
- To evaluate the potential of ARNi in reducing arrhythmogenesis and SCD in heart failure patients.
Main Methods:
- Literature review and synthesis of available studies.
- Focus on evidence concerning sacubitril/valsartan and its impact on cardiac rhythm and SCD.
Main Results:
- Angiotensin receptor and neprilysin inhibitor (ARNi) has demonstrated efficacy in reducing cardiovascular mortality and hospitalizations in patients with heart failure with reduced ejection fraction (HFrEF).
- Emerging evidence suggests a potential role for ARNi in mitigating arrhythmogenesis.
- This may translate to a reduced risk of sudden cardiac death (SCD) in the HF population.
Conclusions:
- This review consolidates current data on ARNi, specifically sacubitril/valsartan.
- The findings highlight the potential antiarrhythmic effects of ARNi.
- Further research may confirm ARNi's role in preventing SCD in heart failure.
Introduction:
Heart failure (HF) is a major cause of morbidity and mortality, with nearly half of all HF-related deaths resulting from sudden cardiac death (SCD), most often from an arrhythmic event. The pathophysiologic changes that occur in response to the hemodynamic stress of HF may lead to increased arrhythmogenesis. Theoretically, medications that block these arrhythmogenic substrates would decrease the risk of SCD. The combined angiotensin receptor and neprilysin inhibitor (ARNi; tradename Entresto) is the newest commercially available medication for the treatment of heart failure.
Methods And Results:
We reviewed and synthesized the available literature regarding sacubitril/valsartan and its effects on cardiac rhythm. ARNi has been shown to decrease cardiovascular mortality and hospitalization in patients with HF with reduced ejection fraction (HFrEF). Emerging evidence suggests that ARNi also may play a role in reducing arrhythmogenesis and thereby SCD.
Conclusion:
This review summarizes the current data regarding this ARNi and its potential antiarrhythmic effects.
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