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

Vincenzo Russo,Riccardo Proietti,Gerardo Nigro,Paolo Golino,Andrea Antonio Papa,Roberta Bottino,Biagio Liccardo,Vincenzo Manna,Anna Rago,Antonio D’Onofrio

doi:10.3390/jcm9041111

Abstract

Sacubitril/valsartan therapy reduces sudden cardiac death (SCD) among patients with reduced ejection fraction (HFrEF) when compared to guidelines recommended doses of enalapril, however the mechanism is still not clear. There are few, contrasting results about the effect of sacubitril/valsartan on arrhythmias in the clinical context of dilated cardiomyopathy (DCM) and there are no clinical data about its effect on measured implantable cardioverter defibrillator (ICD) electrical parameters, such as atrial/ventricular electrograms sensing and pacing threshold. We conducted a 12 month follow-up observational study in 167 ischemic and nonischemic DCM patients (mean age 68.1 ± 11.6 years; 85% male), with dual-chamber ICD on sacubitril/valsartan treatment, to evaluate the incidence of device detected tachyarrhythmia events, both atrial and ventricular, and the change in measured ICD electrical parameters. We collected data on clinical, electrocardiographic and echocardiographic parameters to find a possible electro-mechanical correlation within results. Our results show that DCM patients with reduced ejection fraction and ICD on sacubitril/valsartan treatment experienced a reduction in both atrial and ventricular arrhythmias incidence and an improvement in ICD electrical atrial parameters. The findings might be explained by the electro-mechanical cardiac reverse remodeling induced by sacubitril/valsartan therapy.

Highlights

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; no information about the mechanism leading to sudden cardiac death (SCD) was provided in the randomized control trial [1]
Our results show that dilated cardiomyopathy (DCM) patients with reduced ejection fraction and implantable cardioverter defibrillator (ICD) on sacubitril/valsartan treatment experienced a reduction in both atrial and ventricular arrhythmias incidence and an improvement in ICD electrical atrial parameters
From a large cohort of 1237 patients with DCM, both ischemic and non-ischemic, who underwent ICD implantation and were followed from January 2015 to January 2018 at our hospital, we evaluated 765 ICD recipients with DCM, left ventricular ejection fraction (LVEF) ≤40%, functional (New York Heart Association (NYHA) class II—despite optimal medical therapy—who were in need of sacubitril/valsartan therapy according to the current guidelines

Summary

Introduction

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; 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]. We sought to evaluate the incidence of device-detected tachyarrhythmia events, both atrial and ventricular, and the change in measured ICD electrical parameters among dilated cardiomyopathy (DCM) patients with ICD on sacubitril/valsartan treatment during a 12 month follow-up

Methods

Results

Discussion

Conclusion