PMID- 36874318 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20230307 IS - 2168-8184 (Print) IS - 2168-8184 (Electronic) IS - 2168-8184 (Linking) VI - 15 IP - 2 DP - 2023 Feb TI - The Effect of Sacubitril-Valsartan on Ventricular Arrhythmia Burden in Patients With Heart Failure With Reduced Ejection Fraction. PG - e34508 LID - 10.7759/cureus.34508 [doi] LID - e34508 AB - Introduction Heart failure with reduced ejection fraction (HFrEF) patients are prone to developing ventricular arrhythmias. In the PARADIGM-HF trial, sacubitril-valsartan (SV) showed a reduction in the composite endpoint of death and HF hospitalization in HFrEF patients; subgroup analysis of this trial revealed a reduction in both sudden death and deaths from worsening HF. The mechanism by which SV may affect the incidence of ventricular arrhythmias is currently under debate, and the literature provides conflicting results. The aim of our study was to evaluate the potential antiarrhythmic effect of this drug in patients with HFrEF carrying an implantable cardiac defibrillator (ICD) or a cardiac resynchronization therapy with a defibrillator (CRT-D). Methods This was a single-center, observational and retrospective study. Inclusion criteria were implantation of an ICD or CRT-D device between 2009 and 2019, age >/=18 years, left ventricle ejection fraction (LVEF) /=II, and treatment with an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker for at least 12 months, followed by replacement with SV. Exclusion criteria were NYHA class IV, frequent alterations in chronic medication for HFrEF, and implantation of an ICD or CRT-D after the introduction of SV. The primary outcome was the occurrence of ventricular arrhythmias in the form of appropriate device shocks, ventricular fibrillation, or ventricular tachycardia. The comparisons were performed between two periods of time (12 months before and 12 months after SV) in the same group of patients. Results Fifty-four patients met the inclusion criteria. The mean age was 69.5 +/- 1.65 years, and 74.1% of patients were male. The number of patients experiencing appropriate shocks was significantly lower after SV initiation (2% vs. 18%; p=0.016). The percentage of VT (13 vs. 20%; p=0.549) and VF episodes (4% vs. 13% for VF; p=0.289) were also lower, but these differences were not statistically significant. There were no significant differences in the value of NT-proBNP (1128 vs. 775 pg/mL; p=0.858), LVEF (28.4 vs. 29.6%; p=0.315), and left ventricular end-diastolic diameter (65.0 vs. 66.0 mm; p=0.5492). Conclusion SV seems to reduce the risk of arrhythmic events requiring appropriate shock therapy. CI - Copyright (c) 2023, Medeiros et al. FAU - Medeiros, Paulo AU - Medeiros P AD - Cardiology, Hospital de Braga, Braga, PRT. FAU - Coelho, Claudia AU - Coelho C AD - Cardiology, University of Minho, Braga, PRT. FAU - Costa-Oliveira, Catia AU - Costa-Oliveira C AD - Cardiology, Hospital de Braga, Braga, PRT. FAU - Rocha, Sergia AU - Rocha S AD - Cardiology, Hospital de Braga, Braga, PRT. LA - eng PT - Journal Article DEP - 20230201 PL - United States TA - Cureus JT - Cureus JID - 101596737 PMC - PMC9984117 OTO - NOTNLM OT - cardiac resynchronization therapy (crt) OT - heart failure with reduced ejection fraction OT - implantable cardiac defibrillator (icd) OT - sacubitril-valsartan OT - ventricular arrhythmia COIS- The authors have declared that no competing interests exist. EDAT- 2023/03/07 06:00 MHDA- 2023/03/07 06:01 PMCR- 2023/02/01 CRDT- 2023/03/06 03:54 PHST- 2023/01/29 00:00 [accepted] PHST- 2023/03/06 03:54 [entrez] PHST- 2023/03/07 06:00 [pubmed] PHST- 2023/03/07 06:01 [medline] PHST- 2023/02/01 00:00 [pmc-release] AID - 10.7759/cureus.34508 [doi] PST - epublish SO - Cureus. 2023 Feb 1;15(2):e34508. doi: 10.7759/cureus.34508. eCollection 2023 Feb.