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

Wang, Qiqi; Zhuo, Chengui; Xia, Qi; Jiang, Jiajia; Wu, Bifeng; Zhou, Dongchen; Shu, Zheyue; Zhao, Jianqiang; Chen, Heng; Sun, Zewei; Zhang, Biqi; Han, Jie; Zheng, Liangrong

doi:10.1007/s10557-022-07315-1

Cited by 15 publications

(15 citation statements)

References 26 publications

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Section: Cardiac Arrhythmiamentioning

confidence: 84%

“…Sacubitril/valsartan also has therapeutic effects on AF. In patients with persistent AF who underwent radiofrequency ablation the probability of AF is significantly lower in patients treated with sacubitril/valsartan after 12 months of intervention than in patients treated with valsartan for the same duration ( 97 ). However, sacubitril/valsartan treatment did not significantly differ from enalapril or valsartan in preventing the development of AF in patients with HF in a meta-analysis of a randomized, double-blind, active controlled trial involving 15,512 patients.…”

Section: Disease Application Of Sacubitril/valsartanmentioning

confidence: 99%

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The history and mystery of sacubitril/valsartan: From clinical trial to the real world

Zhang

Zou

Wang

et al. 2023

Front. Cardiovasc. Med.

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Heart failure is a serious threat to human health, with morbidity and mortality rates increasing despite the existence of multiple treatment options. Therefore, it is necessary to identify new therapeutic targets for this disease. Sacubitril/valsartan is a supramolecular sodium salt complex of the enkephalinase inhibitor prodrug sacubitril and the angiotensin receptor blocker valsartan. Its combined action increases endogenous natriuretic peptides while inhibiting the renin-angiotensin-aldosterone system and exerting cardioprotective effects. Clinical evidence suggests that sacubitril/valsartan is superior to conventional renin-angiotensin-aldosterone inhibitor therapy for patients with reduced ejection fraction heart failure who can tolerate angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers. The therapy reduces the risk of heart failure hospitalization, cardiovascular mortality, and all-cause mortality and has a better safety and tolerability record. This review describes the potential pathophysiological mechanisms of cardiomyocyte injury amelioration by sacubitril/valsartan. We explore the protective effects of sacubitril/valsartan and outline the therapeutic value in patients with heart failure by summarizing the results of recent large clinical trials. Furthermore, a preliminary outlook shows that sacubitril/valsartan may be effective at treating other diseases, and provides some exploratory observations that lay the foundation for future studies on this drug.

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Section: Cardiac Arrhythmiamentioning

confidence: 84%

Section: Disease Application Of Sacubitril/valsartanmentioning

confidence: 99%

The history and mystery of sacubitril/valsartan: From clinical trial to the real world

Zhang

Zou

Wang

et al. 2023

Front. Cardiovasc. Med.

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“…However, the recent PARADISE-MI study found that sacubitril/valsartan did not achieve statistical significance in reducing cardiovascular death or overall HF in patients with acute MI 15 . Nevertheless, several clinical studies have shown that sacubitril/valsartan is superior to traditional RAAS inhibitors in improving atrial structural remodeling and reducing AF recurrence in patients with AF after catheter ablation 16,17 .…”

Section: Discussionmentioning

confidence: 99%

Angiotensin receptor-neprilysin inhibitor delays progression from paroxysmal to persistent atrial fibrillation

Dong

Zhai

Wang

et al. 2023

Sci Rep

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Progression from paroxysmal to persistent atrial fibrillation (AF) is linked to adverse clinical outcomes. The present study sought to clarify whether angiotensin receptor-neprilysin inhibitor (ARNI) can delay AF progression. A retrospective cohort study was conducted on consecutive patients with paroxysmal AF admitted at the Second Affiliated Hospital of Nanchang University between January 2017 and January 2022. The risk of AF progression from paroxysmal to persistent was compared between paroxysmal patients treated with ARNI and those who received an angiotensin receptor blocker (ARB). Seven-day Holter monitoring was performed to identify persistent AF. Propensity-score matched analysis was performed to compare the two groups. Cox-regression was used to estimate the hazard ratio (HR) for AF progression events. A total of 1083 patients were screened, and 113 patients in the ARB group and 57 patients in the ARNI group were eligible for analysis. Before propensity-score matching, the ARNI therapy was associated with a lower risk of AF progression than the ARB therapy (HR 0.34; 95% confidence interval [CI] 0.14–0.81; P = 0.015) after a median follow-up of 705 (interquartile range [IQR] 512 to 895) days. Among 170 patients, 47 ARNI-treated patients were successfully matched to 47 ARB-treated patients. After a median follow-up of 724 (541–929) days, compared to ARB, ARNI significantly reduced the risk of AF progression (HR 0.32; 95% CI 0.12–0.88; P = 0.016). ARNI may be superior to ARB in reducing the risk of progression from paroxysmal to persistent AF.

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“…Yang et al found that LAD and RAD were lower in ARNI group patients compared to ARB group at the 24-week follow-up after AF ablation, indicating that ARNI is superior to ARB in attenuating atrial structural remodeling in RFCA-treated AF patients ( 27 ). Wang et al found patients in ARNI group had a lower AF recurrence rate at 1-year follow-up after persistent AF catheter ablation compared to ARB group ( 28 ).…”

Section: Discussionmentioning

confidence: 99%

Effect of angiotensin receptor-neprilysin inhibitor on atrial electrical instability in atrial fibrillation

Zhu

Zhang

Yang

et al. 2022

Front. Cardiovasc. Med.

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Background and objectiveAround 33.5 million patients suffered from atrial fibrillation (AF), causing complications and increasing mortality and disability rate. Upstream treatment for AF is getting more popular in clinical practice in recent years. The angiotensin receptor-neprilysin inhibitor (ARNI) is one of the potential treatment options. Our study aimed to investigate the effect of ARNI on atrial electrical instability and structural remodeling in AF.MethodsOur research consisted of two parts – a retrospective real-world clinical study and an animal experiment on calmness to verify the retrospective founding. In the retrospective study, we reviewed all patients (n = 110) who had undergone the first AF ablation from 1 August 2018 to 1 March 2022. Patients with ARNI (n = 36) or angiotensin II receptor antagonist (ARB) (n = 35) treatment were enrolled. Their clinical data, ultrasound cardiogram (UCG) and Holter parameters were collected before radiofrequency catheter ablation (RFCA) as baseline and at 24-week follow-up. Univariate and multivariate logistic regression analysis were performed. In the animal experiment, we established an AF model (n = 18) on canines by rapid atrial pacing. After the successful procedure of pacing, all the 15 alive beagles were equally and randomly assigned to three groups (n = 5 each): Control group, ARB group, and ARNI group. UCG was performed before the pacing as baseline. Physiological biopsy, UCG, and electrophysiological study (EPS) were performed at 8-week.ResultsClinical data showed that the atrial arrhythmia rate at 24-week was significantly lower in ARNI group compared to ARB group (P < 0.01), and ARNI was independently associated with a lower atrial arrhythmia rate (P < 0.05) at 24-week in multivariate regression logistic analysis. In the animal experiment, ARNI group had a higher atrial electrical stability score and a shorter AF duration in the EPS compared to Control and ARB group (P < 0.05). In the left atrium voltage mapping, ARNI group showed less low voltage and disordered zone compared to Control and ARB group. Compared to Control group, right atrium diameter (RAD), left ventricle end-diastolic volume index (LVEDVI), E/A, and E/E′ were lower in ARNI group (P < 0.05) at the 8-weeks follow-up, while left atrium ejection fraction (LAEF) and left ventricle ejection fraction (LVEF) were higher (P < 0.01). Compared to ARB group, LVEF was higher in ARNI group at the 8-week follow-up (P < 0.05). ARB and ARNI group had a lower ratio of fibrotic lesions in the left atrium tissues compared to Control group (P < 0.01), but no difference was found between the ARB and the ARNI group.ConclusionARNI could reduce atrial electrical instability in AF in comparison with ARB in both retrospective study and animal experiment.

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

Cited by 15 publications

References 26 publications

The history and mystery of sacubitril/valsartan: From clinical trial to the real world

The history and mystery of sacubitril/valsartan: From clinical trial to the real world

Angiotensin receptor-neprilysin inhibitor delays progression from paroxysmal to persistent atrial fibrillation

Effect of angiotensin receptor-neprilysin inhibitor on atrial electrical instability in atrial fibrillation

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