Sacubitril/valsartan reduces ventricular arrhythmias in parallel with left ventricular reverse remodeling in heart failure with reduced ejection fraction

The Effect of Sacubitril/Valsartan on Device Detected Arrhythmias and Electrical Parameters among Dilated Cardiomyopathy Patients with Reduced Ejection Fraction and Implantable Cardioverter Defibrillator

“…Moreover, we showed a statistically significant reduction in the number of patients who experienced VT/VF episodes, both sustained and non-sustained, and appropriate ICD shock events on sacubitril/valsartan treatment at 12 months follow-up. These results may be a consequence of the mechanical and functional reverse ventricular remodeling, since we documented the reduction in ventricular volumes and the improvement in left ventricular function, both systolic and diastolic, confirming the evidences from previous studies [2,15]. However, in contrast with Gonçalves et al [9], we showed a trend in improvement in electrocardiographic indexes of dispersion of ventricular repolarization, which did not reach the statistical significance.…”

“…There are few real-world data about the clinical performance of sacubitril/valsartan among patients with heart failure and implantable cardioverter defibrillators [2][3][4]. Therefore little is known about the effect of sacubitril/valsartan on device-detected arrhythmias, both ventricular and atrial [2][3][4][5][6][7][8], and there are no reliable data on ICD electrical parameters among patients with heart failure on sacubitril/valsartan treatment.…”

“…Sacubitril/valsartan therapy demonstrated superiority in reducing the risks of death and hospitalization for heart failure (HF) among patients with reduced ejection fraction (HFrEF) when compared to guideline recommended doses of enalapril; however, no information about the mechanism leading to sudden cardiac death (SCD) was provided in the randomized control trial [1]. There are few and contrasting real-world data about the incidence of device detected tachyarrhythmias in HFrEF patients with implantable cardioverter defibrillators (ICD) treated with sacubitril/valsartan [2][3][4], and its possible direct antiarrhythmic effect is still debated [5][6][7][8][9][10]. Moreover, there are no clinical data about the effect of sacubitril/valsartan therapy on measured ICD electrical parameters, such as atrial/ventricular electrograms sensing and pacing threshold.…”

Sacubitril/Valsartan Induces Global Cardiac Reverse Remodeling in Long-Lasting Heart Failure with Reduced Ejection Fraction: Standard and Advanced Echocardiographic Evidences

“…Finally, important considerations on ICD implantation in primary prevention could be raised from the present results. The significant effect of sacubitril/valsartan on all the considered parameters evaluated in this study, also in long-standing diseases, could be consistent with a demonstrated decreased burden of ventricular arrhythmias and ICD appropriate interventions induced by the drug [8,22]. It emerges the need of future prospective trials focused on the cost effectiveness of a further optimization of the therapy shifting to sacubitril/valsartan before ICD implantation.…”

Pharmacological Inhibition of Serine Proteases to Reduce Cardiac Inflammation and Fibrosis in Atrial Fibrillation

“…Recent studies showed that the fixed combination of an ARB (valsartan) with a neprilysin inhibitor (sacubitril) was able to reduce cardiac fibrosis and the risk of ventricular arrhythmias and sudden death in patients with heart failure (Sarrias and Bayes-Genis, 2018;Aimo et al, 2019;Martens, 2019). However, the valsartan/sacubitril combination does not appear to have additional beneficial effects on atrial arrhythmic burden, as compared with ARBs or ACE-I alone (Martens, 2019). Neprilysin catalyzes the degradation of natriuretic peptides (atrial-and brain-derived natriuretic peptides, ANP, and BNP, respectively), which have anti-fibrotic effects.…”