Key result
Sacubitril/valsartan linked to ~67% lower odds of ICD shocks in heart failure patients.
Why the study?
While antiarrhythmic effects of sacubitril/valsartan in HF have been reported, its impact among individuals with ventricular arrhythmias with cardiac defibrillators remains unclear.
Does sacubitril/valsartan reduce the incidence of ICD shocks and ventricular arrhythmias in heart failure patients with implanted cardiac defibrillators?
Meta-Analysis (n=397)
Yes
Does sacubitril/valsartan reduce the incidence of ICD shocks and ventricular arrhythmias in heart failure patients with implanted cardiac defibrillators?
Answers are grounded in this paper and cite their sources.
In pooled observational cohorts of HFrEF patients with ICD or CRT devices, sacubitril/valsartan initiation was associated with a substantial reduction in overall and appropriate ICD shocks and improved biventricular pacing.
Introduction Antiarrhythmic effects of sacubitril/valsartan in heart failure (HF) have been previously reported; however, its impact among individuals with ventricular arrhythmias with cardiac defibrillators remains unclear. Therefore, we performed this systematic review and meta‐analysis to address this lack of evidence. Method A systematic search of PubMed, Embase, and Cochrane Library was conducted from inception until February 26, 2025. Binary and continuous variables were analyzed by odds ratio (OR) and mean differences, respectively. All analyses were performed using a random‐effects model by RevMan. Results Four paired observational cohort studies, including 397 patients with HF and implanted cardiac defibrillators (ICDs) were enrolled. This study showed that sacubitril/valsartan could significantly reduce the incidence of ICD shocks (OR, 0.33; 95% CI, 0.19 to 0.60; p = 0.0003; I 2 = 13%), appropriate ICD shocks (OR, 0.21; 95% CI, 0.10 to 0.47; p = 0.0001; I 2 = 0%), NSVT duration (OR, −1.86; 95% CI, −3.43 to −0.30; p = 0.02; I 2 = 86%), and biventricular (Biv) pacing < 90% (OR, 0.15; 95% CI, 0.03 to 0.83; p = 0.03; I 2 = 0%). However, the mata‐analysis didn't reveal a significant association between sacubitril/valsartan and a lower rate of ventricular arrhythmia, sustained ventricular tachycardia (SVT), non‐sustained ventricular tachycardia (NSVT), inappropriate ICD shocks, premature ventricular contractions per hour (PVC/h), and left ventricular ejection fraction (LVEF). Conclusion Sacubitril/valsartan may have a potential benefit among HF patients with cardiac defibrillators; future investigations are warranted to confirm the antiarrhythmic effects of sacubitril/valsartan in this setting.
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Asham et al. (2025) conducted a meta-analysis in Heart failure with implanted cardiac defibrillators (ICD or CRT) (n=397). Sacubitril/valsartan vs. Control period before initiation of sacubitril/valsartan (paired pre-post comparison) was evaluated on Incidence of ICD shocks (OR 0.33, 95% CI 0.19-0.60, p=0.0003). Sacubitril/valsartan was associated with a reduced incidence of ICD shocks and appropriate ICD shocks in HF patients with ICDs.
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