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

IF 2.8 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiovascular Drugs Pub Date : 2024-10-29 DOI:10.1007/s40256-024-00691-z

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

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引用次数: 0

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.

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沙库比妥-缬沙坦可降低导管消融术后心房颤动复发率和左心房容积：系统综述与元分析》。

导言：在接受导管消融术的房颤（AF）患者中，沙库比妥-缬沙坦（SV）与血管紧张素转换酶抑制剂（ACEi）或血管紧张素受体阻滞剂（ARB）在预防房颤复发方面的疗效对比仍不明确。本系统综述和荟萃分析的目的是确定 SV 在这种临床环境中是否具有更优越的疗效：本研究系统回顾了 PubMed、Embase 和 Cochrane 图书馆中的随机对照试验 (RCT) 和倾向匹配队列 (PMC)，评估了 SV 在预防导管消融术后房颤复发方面的疗效。结果包括房颤复发和结构重塑，通过左心室射血分数（LVEF）和左心房容积指数（LAVi）进行评估，使用Review Manager 5.1.7进行统计分析，通过I2统计评估异质性：分析包括来自三项RCT和一项PMC的642名患者（其中319人接受过SV治疗）。SV 能明显降低房颤复发率[风险比 (RR) 0.54; 95% 置信区间 (CI) 0.41-0.70; p < 0.00001; I2 = 0%]，如果只考虑 RCT，也能观察到这一趋势（RR 0.58; 95% CI 0.41-0.84; p = 0.004; I2 = 0%）。此外，与 ARB 相比，SV 显著降低了 LAVi [平均偏差 (MD) -5.34 mL/m2; 95% CI -8.77 to -1.91; p = 0.002; I2 = 57%]，同时显著改善了 LVEF (MD 1.83%; 95% CI 1.35-2.32; p < 0.00001; I2 = 0%)。对高血压和 LVEF < 50% 的患者进行的亚组分析也表明，SV 可降低房颤复发率：结论：与 ACEi 或 ARB 相比，SV 治疗在减少房颤复发方面表现出更佳的疗效，并在减轻导管消融术后的心房结构重塑方面表现出更佳的效果。这些发现强调了SV作为接受导管消融术的房颤患者治疗选择的潜力，突出了其在减轻房颤复发和结构重塑方面的疗效：注册：PROSPERO 识别号 CRD42024497958。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American Journal of Cardiovascular Drugs 医学-心血管系统

CiteScore

6.70

自引率

3.30%

发文量

审稿时长

>12 weeks

期刊介绍： Promoting rational therapy within the discipline of cardiology, the American Journal of Cardiovascular Drugs covers all aspects of the treatment of cardiovascular disorders, particularly the place in therapy of newer and established agents. Via a program of reviews and original clinical research articles, the journal addresses major issues relating to treatment of these disorders, including the pharmacology, efficacy and adverse effects of the major classes of drugs; information on newly developed drugs and drug classes; the therapeutic implications of latest research into the aetiology of cardiovascular disorders; and the practical management of specific clinical situations. The American Journal of Cardiovascular Drugs offers a range of additional enhanced features designed to increase the visibility, readership and educational value of the journal’s content. Each article is accompanied by a Key Points summary, giving a time-efficient overview of the content to a wide readership. Articles may be accompanied by plain language summaries to assist patients, caregivers and others in understanding important medical advances. The journal also provides the option to include various other types of enhanced features including slide sets, videos and animations. All enhanced features are peer reviewed to the same high standard as the article itself. Peer review is conducted using Editorial Manager®, supported by a database of international experts. This database is shared with other Adis journals.