How do arrhythmia markers change on the ECG of patients using ARNI?

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Heart failure with reduced ejection fraction (n=234). Intervention: Sacubitril/valsartan vs. Baseline (pre-treatment values). Primary outcome: QTc interval duration (ms) (p=<0.001).

Q: What does this research mean for the field?

Sacubitril/valsartan therapy significantly reduces ventricular repolarization and arrhythmia markers—including QT, QTc, QT dispersion, Tp-e, and Tp-e/QTc ratio—in patients with heart failure with reduced ejection fraction. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Fatih Öztürk; Mehmet Yaman

doi:10.5505/ejm.2026.88864

January 1, 2026Eastern Journal Of MedicineOpen Access

How do arrhythmia markers change on the ECG of patients using ARNI?

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Why the study?

This study was conducted to examine electrocardiographic changes and arrhythmia markers in heart failure patients with low ejection fraction receiving sacubitril/valsartan.

Does sacubitril/valsartan improve electrocardiographic arrhythmia and ventricular repolarization markers (QT, QTc, QTd, Tp-e, Tp-e/QTc) at 12 months in patients with heart failure and low ejection fraction?

Study Design

Type

Observational (n=234)

Blinding

Single-blind (cardiologist reading ECGs was blinded to patient identities)

Multicenter

No

Structured PICO

Does sacubitril/valsartan improve electrocardiographic arrhythmia and ventricular repolarization markers (QT, QTc, QTd, Tp-e, Tp-e/QTc) at 12 months in patients with heart failure and low ejection fraction?

P

Population

234 patients (mean age 62 years, 46.2% female) with heart failure with reduced ejection fraction (mean EF 36.3%), free of baseline known arrhythmias, evaluated retrospectively 12 months after initiating sacubitril/valsartan.

E

Exposure

Sacubitril/valsartan (S/V) therapy added to background heart failure treatment (including SGLT2 inhibitors in 73.5%, beta-blockers in 75.6%, diuretics in 66.2%, and spironolactone in 57.7%) for 12 months

C

Comparator

Baseline (pre-treatment) ECG measurements prior to sacubitril/valsartan initiation (within-group pre-post comparison)

O

Outcome

Electrocardiographic ventricular repolarization and arrhythmia markers (QT, QTc, QTd, Tp-e, and Tp-e/QTc ratio) at 12 months after treatment initiation, measured by a cardiologist blinded to patient identitiessurrogate

Main Result

Absolute Event Rate: 403.1% vs 423.7%

p-value: p=<0.001

In patients with heart failure and reduced ejection fraction, 12 months of sacubitril/valsartan therapy was associated with significant reductions in ECG repolarization markers (QT, QTc, QTd, Tp-e, and Tp-e/QTc), suggesting a potential favorable effect on ventricular arrhythmia risk.

Limitations

Retrospective study design precluding clear examination of progressive patient development
Relatively small sample size
Single-center study with lack of diversity in the patient population
Inability to fully isolate the interaction of sacubitril/valsartan from other concomitant heart failure medications (such as SGLT2 inhibitors and beta-blockers)
Underlying antiarrhythmic mechanisms were not evaluated in laboratory settings
Retrospective study design, which precludes clear examination of progressive patient development
Absence of diversity in the patient population, precluding meaningful commentary on interactions with other pharmaceutical agents
Unexplained mechanism of the antiarrhythmic effect requiring further laboratory research

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Implication

Sacubitril/valsartan was associated with QTc shortening in HFrEF; hypothesis-generating and requires randomized confirmation before practice change.

Abstract

The objective of this study was to examine the electrocardiographic changes in heart failure patients with low ejection fraction receiving sacubitril/valsartan(S/V). The study comprised 234 patients diagnosed with heart failure and undergoing treatment between 2020 and 2025, whose files were retrospectively reviewed.The ECG findings were subject ed to thorough analysis and meticulous recording.An evaluation of the treatment characteristics revealed that all patients were receiving S/V therapy, with 73.5 % of patients using SGLT2 inhibitors, 75.6% using beta-blockers, 66.7% using acetylsalicylic acid, 42.3% using P2Y12 inhibitors, 66.2% using diuretics, and 57.7% using spironolactone.Subsequent to S/V administration, a decline in the QT, QTc, QTd, Tp -e, and Tp-e/QTc values was observed on the ECG (p<0.001).In the context of heart failure treatment, S/V therapy has been observed to effect positive changes in ECG findings and markers of arrhythmia

Discussion

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Cite This Study

Öztürk et al. (2026) conducted an observational in Heart failure with reduced ejection fraction (n=234). Sacubitril/valsartan vs. Baseline (pre-treatment values) was evaluated on QTc interval duration (ms) (p=<0.001).

synapsesocial.com/papers/6af0e9a6de503f3774140ad8 https://doi.org/10.5505/ejm.2026.88864

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How do arrhythmia markers change on the ECG of patients using ARNI?

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

How do arrhythmia markers change on the ECG of patients using ARNI?

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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