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

期刊论文
发表日期：

2024年10月29日

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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

摘要

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.

Graphical Abstract