INTRODUCTION:

Among patients with atrial fibrillation (AF) who underwent catheter ablation, it is unclear whether AF recurrence is lower in those who receive Sacubitril-Valsartan (SV) than in those who receive ACEi (angiotensin-converting enzyme inhibitor) or ARB (angiotensin-receptor blocker).

Hypothesis:

Is SV more effective than ACEi/ARB in decreasing AF recurrence after catheter ablation? METHODS: We systematically searched PubMed, Embase, and Cochrane Library for randomized controlled trials (RCTs) and propensity-matched cohorts (PMC), evaluating the efficacy of SV for preventing AF recurrence in patients who underwent catheter ablation. The outcomes of interest were AF recurrence and structural remodeling, assessed by Left Ventricular Ejection Fraction (LVEF) and Left Atrial Volume Index (LAVi). Statistical analysis was performed using RevMan 5.1.7. Heterogeneity was assessed with I² statistics.

RESULTS:

We included 2 RCTs and 1 PMC, comprising 517 patients, of whom 256 were treated with SV, 101 received ARB, and 155 ACEis. AF recurrence was significantly lower in the SV group (RR 0.50; 95% CI 0.37-0.68; p<0.00001; I²=0%; Figure 1A), even considering only RCTs (RR 0.55; 95% CI 0.34-0.91; p=0.03; I²=0%). Also, SV was associated with a significant decrease in LAVi (MD -5.34 mL/m²; 95% CI -8.77 to -1.91; p=0.002; I²=57%; Figure 1B) compared to ARB. LVEF was similar between groups (MD 1.24 %; 95% CI -0.12 to 2.60; p=0.07; I²=0%).

CONCLUSIONS:

SV therapy was associated with a decreased risk of AF recurrence compared to ACEi or ARB, and was superior to ARB in attenuating atrial structural remodeling in patients submitted to catheter ablation.