Vericiguat in patients with heart failure and implantable cardioverter-defibrillator

Background: This analysis assesses the effectiveness and tolerability profile of vericiguat in patients with heart failure with reduced ejection fraction (HFrEF) and implantable cardioverter-defibrillator, with an emphasis on the emergence of ventricular arrhythmias. Methods: Retrospective analysis of patients with HFrEF and implantable cardioverter-defibrillator who started treatment with vericiguat in daily clinical practice in a tertiary university hospital in Spain. Results: The study population comprised 14 patients treated since January 2023. At baseline, mean age was 77.0±7.0 years, 71.4% of patients were men and mean left ventricular ejection fraction was 32.1±5.4%. Regarding heart failure treatments, 13 (92.3%) patients were prescribed renin-angiotensin-aldosterone system inhibitors, mainly sacubitril-valsartan (61.5%), they were all prescribed aldosterone antagonists, 10 (71.4%) were prescribed β-blockers and 10 (71.4%) were prescribed sodium-glucose cotransporter-2 (SGLT2) inhibitors. After a mean duration of treatment with vericiguat of 12.4±5.3 months, two (14.3%) patients presented to the emergency department, one with hypotension and the other with impaired kidney function, and a further two (14.3%) patients were hospitalised, one of whom had decompensated heart failure. At baseline, four (28.6%) patients presented non-sustained/sustained ventricular tachycardia; at study end, this decreased to two patients (50% of patients with ventricular arrhythmias at baseline). Additionally, in one patient (25% of patients with ventricular arrhythmias at baseline), there was a substantial reduction in the number of episodes of ventricular arrhythmia. At study end, seven patients achieved the target dose of 10 mg daily and one patient discontinued vericiguat owing to hypotension. Conclusions: Amongst patients with HFrEF and implantable cardioverter-defibrillator, vericiguat showed a good safety profile in addition to standard heart failure therapy, with low rates of adverse events. Moreover, a potential reduction in the risk of ventricular arrhythmias could also be obtained with vericiguat.