Sacubitril-Valsartan Lowers Atrial Fibrillation Recurrence and Left Atrial Volume Post-catheter Ablation: Systematic Review and Meta-Analysis

Larissa Araújo de Lucena; Marcos Aurélio Araújo Freitas; Camila Mota Guida; Larissa C Hespanhol; Ana Karenina C de Sousa; Júlio César V de Sousa; Ferdinand Gilbert S Maia

doi:10.1007/s40256-024-00691-z

Sacubitril-Valsartan Lowers Atrial Fibrillation Recurrence and Left Atrial Volume Post-catheter Ablation: Systematic Review and Meta-Analysis

Am J Cardiovasc Drugs. 2024 Oct 29. doi: 10.1007/s40256-024-00691-z. Online ahead of print.

Authors

Larissa Araújo de Lucena¹, Marcos Aurélio Araújo Freitas², Camila Mota Guida³, Larissa C Hespanhol⁴, Ana Karenina C de Sousa⁵, Júlio César V de Sousa⁵, Ferdinand Gilbert S Maia⁵

Affiliations

¹ Department of Integrated Medicine, Federal University of Rio Grande do Norte, 620 Nilo Peçanha Avenue, Petrópolis, Natal, Rio Grande do Norte, 59012-300, Brazil. larissa.js@hotmail.com.
² Department of Medicine, State University of Região Tocantina do Maranhão, Imperatriz, Maranhão, Brazil.
³ Division of Cardiology, Dante Pazzanese Institute of Cardiology, São Paulo, SP, Brazil.
⁴ Department of Medicine, Federal University of Campina Grande, Cajazeiras, Paraíba, Brazil.
⁵ Department of Integrated Medicine, Federal University of Rio Grande do Norte, 620 Nilo Peçanha Avenue, Petrópolis, Natal, Rio Grande do Norte, 59012-300, Brazil.

PMID: 39470948
DOI: 10.1007/s40256-024-00691-z

Abstract

Introduction: In patients with atrial fibrillation (AF) who have undergone catheter ablation, the comparative effectiveness of sacubitril-valsartan (SV) versus ACE inhibitors (ACEi) or angiotensin-receptor blockers (ARB) in preventing AF recurrence remains unclear. The purpose of the present systematic review and meta-analysis is to determine whether SV offers superior outcomes in this clinical setting.

Methods: This study systematically reviewed PubMed, Embase, and the Cochrane Library for randomized controlled trials (RCTs) and propensity-matched cohorts (PMC), evaluating SV's efficacy in preventing AF recurrence after catheter ablation. Outcomes included AF recurrence and structural remodeling assessed via left ventricular ejection fraction (LVEF) and left atrial volume index (LAVi), with statistical analyses performed using Review Manager 5.1.7 and heterogeneity assessed via I² statistics.

Results: The analysis comprised 642 patients from three RCTs and one PMC (319 SV-treated). SV significantly reduced AF recurrence [risk ratios (RR) 0.54; 95% confidence intervals (CI) 0.41-0.70; p < 0.00001; I² = 0%), a trend also observed when considering RCTs exclusively (RR 0.58; 95% CI 0.41-0.84; p = 0.004; I² = 0%). Moreover, SV demonstrated a notable reduction in LAVi [mean deviation (MD) -5.34 mL/m²; 95% CI -8.77 to -1.91; p = 0.002; I² = 57%] compared with ARB, alongside a significant improvement in LVEF (MD 1.83%; 95% CI 1.35-2.32; p < 0.00001; I² = 0%). Subgroup analyses among patients with hypertension and LVEF < 50% also indicated lower AF recurrence with SV.

Conclusion: SV therapy exhibited superior efficacy in reducing AF recurrence compared with ACEi or ARB and demonstrated superior outcomes in attenuating atrial structural remodeling after catheter ablation. These findings underscore the potential of SV as a therapeutic option for patients with AF undergoing catheter ablation, highlighting its efficacy in mitigating AF recurrence and structural remodeling.

Registration: PROSPERO identifier number CRD42024497958.

Publication types

Systematic Review