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Sacubitril/valsartan and arrhythmic burden in patients with heart failure and reduced ejection fraction: a systematic

A Pozzi1, R Abete2, E Tavano3

  • 1Cardiology Department, Valduce Hospital, Como, Italy. andreawellsvabg@gmail.com.

Heart Failure Reviews
|June 28, 2023
PubMed

Insights

Switching heart failure patients from ACE-I/ARB to ARNI significantly reduces ventricular arrhythmias. This ARNI treatment also improved biventricular pacing and reduced ICD shocks in chronic heart failure with reduced ejection fraction.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Research

Background:

  • Chronic heart failure with reduced ejection fraction (HFrEF) carries a high risk of ventricular arrhythmias.
  • Angiotensin-converting enzyme inhibitors (ACE-I) and angiotensin receptor blockers (ARB) are standard treatments, but further risk reduction is needed.
  • Angiotensin receptor/neprilysin inhibitors (ARNI) offer a novel therapeutic approach.

Purpose of the Study:

  • To evaluate if ARNI treatment decreases ventricular arrhythmic burden compared to ACE-I/ARB in HFrEF patients.
  • To assess the impact of ARNI on biventricular pacing percentage.
  • To synthesize evidence from randomized controlled trials (RCTs) and observational studies.

Main Methods:

  • Systematic review of Medline and Embase databases up to February 2023.
  • Inclusion of RCTs and observational studies on HFrEF patients switching from ACE-I/ARB to ARNI.
  • Final analysis included 1 RCT and 3 non-RCTs, totaling 8837 patients.

Main Results:

  • ARNI significantly reduced ventricular arrhythmias in both RCTs (RR 0.78) and observational studies (RR 0.62).
  • In observational studies, ARNI decreased sustained (RR 0.36) and non-sustained VT (RR 0.67), and ICD shocks (RR 0.24).
  • ARNI was associated with increased biventricular pacing (2.96%).

Conclusions:

  • Switching from ACE-I/ARB to ARNI is associated with a consistent reduction in ventricular arrhythmic burden in chronic HFrEF.
  • The observed benefits may stem from ARNI's direct pharmacological effects on cardiac remodeling.
  • ARNI represents a promising therapeutic strategy for managing arrhythmias in HFrEF.

Keywords:
Angiotensin receptor/neprilysin inhibitorArrhythmiasHeart failureICD shockSacubitril/valsartanVentricular tachycardia

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