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Sacubitril-Valsartan Lowers Atrial Fibrillation Recurrence and Left Atrial Volume Post-catheter Ablation: Systematic
Larissa Araújo de Lucena1, Marcos Aurélio Araújo Freitas2, Camila Mota Guida3
1Department of Integrated Medicine, Federal University of Rio Grande do Norte, 620 Nilo Peçanha Avenue, Petrópolis, Natal, Rio Grande do Norte, 59012-300, Brazil. larissa.js@hotmail.com.
Insights
Sacubitril-valsartan (SV) significantly reduces atrial fibrillation (AF) recurrence after catheter ablation compared to ACE inhibitors or ARBs. SV also improves cardiac structure, offering a promising therapeutic option for AF patients.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Atrial fibrillation (AF) management post-catheter ablation requires optimal medical therapy.
- Comparative effectiveness of sacubitril-valsartan (SV) versus standard therapies (ACE inhibitors/ARBs) for preventing AF recurrence is not well-established.
Purpose of the Study:
- To systematically review and meta-analyze the efficacy of sacubitril-valsartan (SV) in preventing AF recurrence after catheter ablation.
Main Methods:
- Systematic review of randomized controlled trials (RCTs) and propensity-matched cohorts (PMC) from PubMed, Embase, and Cochrane Library.
- Outcomes assessed: AF recurrence, left ventricular ejection fraction (LVEF), and left atrial volume index (LAVi).
- Statistical analysis using Review Manager 5.1.7 with heterogeneity assessed by I² statistics.
Main Results:
- Analysis included 642 patients (319 on SV), demonstrating a significant reduction in AF recurrence with SV (RR 0.54, p < 0.00001).
- SV significantly reduced LAVi (MD -5.34 mL/m², p = 0.002) and improved LVEF (MD 1.83%, p < 0.00001) compared to ARB.
- Subgroup analyses in hypertensive patients and those with LVEF < 50% also showed reduced AF recurrence with SV.
Conclusions:
- Sacubitril-valsartan (SV) therapy is superior to ACE inhibitors or ARBs in reducing AF recurrence post-catheter ablation.
- SV effectively attenuates atrial structural remodeling, evidenced by reduced LAVi and improved LVEF.
- SV presents a potentially valuable therapeutic option for managing AF and associated cardiac remodeling.
Introduction:
In patients with atrial fibrillation (AF) who have undergone catheter ablation, the comparative effectiveness of sacubitril-valsartan (SV) versus ACE inhibitors (ACEi) or angiotensin-receptor blockers (ARB) in preventing AF recurrence remains unclear. The purpose of the present systematic review and meta-analysis is to determine whether SV offers superior outcomes in this clinical setting.
Methods:
This study systematically reviewed PubMed, Embase, and the Cochrane Library for randomized controlled trials (RCTs) and propensity-matched cohorts (PMC), evaluating SV's efficacy in preventing AF recurrence after catheter ablation. Outcomes included AF recurrence and structural remodeling assessed via left ventricular ejection fraction (LVEF) and left atrial volume index (LAVi), with statistical analyses performed using Review Manager 5.1.7 and heterogeneity assessed via I2 statistics.
Results:
The analysis comprised 642 patients from three RCTs and one PMC (319 SV-treated). SV significantly reduced AF recurrence [risk ratios (RR) 0.54; 95% confidence intervals (CI) 0.41-0.70; p < 0.00001; I2 = 0%), a trend also observed when considering RCTs exclusively (RR 0.58; 95% CI 0.41-0.84; p = 0.004; I2 = 0%). Moreover, SV demonstrated a notable reduction in LAVi [mean deviation (MD) -5.34 mL/m2; 95% CI -8.77 to -1.91; p = 0.002; I2 = 57%] compared with ARB, alongside a significant improvement in LVEF (MD 1.83%; 95% CI 1.35-2.32; p < 0.00001; I2 = 0%). Subgroup analyses among patients with hypertension and LVEF < 50% also indicated lower AF recurrence with SV.
Conclusion:
SV therapy exhibited superior efficacy in reducing AF recurrence compared with ACEi or ARB and demonstrated superior outcomes in attenuating atrial structural remodeling after catheter ablation. These findings underscore the potential of SV as a therapeutic option for patients with AF undergoing catheter ablation, highlighting its efficacy in mitigating AF recurrence and structural remodeling.
Registration:
PROSPERO identifier number CRD42024497958.
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