Abstract 12620: Effect of Sacubitril-valsartan on the Incidence Arrhythmias in Patients With Heart Failure With Reduced Ejection Fraction: A Systematic Review and Meta Analysis

Abstract

Introduction: Sacubitril-Valsartan (ARNI) has known mortality benefit in patients with HFrEF. Nevertheless, little is known of its influence on arrhythmias. The purpose of this study was to investigate its net effect on the incidence of arrhythmias in patients with HFrEF through a systematic review and meta-analysis of published literature. Methods: We searched Medline, Embase & the Cochrane library through April 15th, 2020 for studies including patients with EF 40% or lower treated with ACEI or ARB and transitioned to ARNI, reporting the incidence of any arrhythmias or ICD shocks in patients with either an ICD, CRT, pacemaker or loop recorder. The primary outcome was the incidence of sustained VT, while the secondary outcomes were the incidence of nonsustained VT (NSVT), appropriate ICD shocks, biventricular pacing (BiV-pacing) in patients with CRT, and episodes of atrial tachycardia or fibrillation (AT/AF) > 30 seconds. The Newcastle-Ottawa tool was used to assess studies. A random-effects meta-analysis was performed using pooled proportions and heterogeneity was examined using I2 statistics. Statistical analyses were carried out using Review Manager 5.3 by Cochrane. Results: 330 subjects were pooled from three studies (two retrospective and one prospective). Mean age was 68±9.7. 79% were males. 74% had ischemic cardiomyopathy. Mean EF was 29% and mean NYHA Class was 2.4. ICD was implanted in 51%, of whom 44% had CRT. Mean follow-up time was 11±1.7 months. The odds ratio (OR) for sustained VT, was 0.59 ( p=0.08 ). For NSVT was 0.65 ( p=0.008* ), appropriate ICD shocks 0.59 ( p=0.09 ), BiV-pacing 2.59 ( p=<0.00001* ), and for episodes of AT/AF > 30s. 0.62 ( p=0.03* ). All in favor of ARNI. Conclusions: This meta-analysis demonstrates that in patients with HFrEF who transition from ACEI or ARB to ARNI, there is a tendency of decreasing ventricular & atrial arrhythmias, appropriate ICD shocks, as well as tendency towards increasing BiV-pacing in patients with CRT.