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Efficacy of sacubitril-valsartan vs. angiotensin-converting enzyme inhibitors or angiotensin receptor blockers in preventing atrial fibrillation recurrence after catheter ablation: a systematic review and meta-analysis.
Baía Bezerra, Fernando; Rodrigues Sobreira, Luis Eduardo; Tsuchiya Sano, Vitor Kendi; de Oliveira Macena Lôbo, Artur; Cavalcanti Orestes Cardoso, Jorge Henrique; Alves Kelly, Francinny; Aquino de Moraes, Francisco Cezar; Consolim-Colombo, Fernanda Marciano.
Afiliação
  • Baía Bezerra F; Anhembi Morumbi University, 12235-181, São José Dos Campos, Brazil. fernandobaiabezerra@gmail.com.
  • Rodrigues Sobreira LE; , Avenida Deputado Benedito Matarazzo, 6707, Jardim Das Colinas. São José Dos Campos, SP, Brazil. fernandobaiabezerra@gmail.com.
  • Tsuchiya Sano VK; Federal University of Pará, 68371-040, Altamira, Brazil.
  • de Oliveira Macena Lôbo A; Federal University of Acre, 69920-900, Rio Branco, Brazil.
  • Cavalcanti Orestes Cardoso JH; Federal University of Pernambuco, 50670-901, Recife, Brazil.
  • Alves Kelly F; University of Pernambuco, 50100-130, Recife, Pernambuco, Brazil.
  • Aquino de Moraes FC; Dante Pazzanese Cardiology Institute, 04012-909, São Paulo, Brazil.
  • Consolim-Colombo FM; Federal University of Para, 66075-110, Belem, Brazil.
Herz ; 2024 Sep 23.
Article em En | MEDLINE | ID: mdl-39313691
ABSTRACT

BACKGROUND:

Patients who have undergone catheter ablation for atrial fibrillation (AF) may experience recurrence of this condition. The efficacy of sacubitril-valsartan (S/V) in preventing AF recurrence compared with angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) is not established. This meta-analysis aimed to establish the best therapeutic choice for preventing AF recurrence after catheter ablation.

METHOD:

A systematic search of the PubMed, Embase, and Cochrane databases was conducted for randomized controlled trials (RCTs) and observational studies comparing the use of S/V with ACEI/ARB in patients who underwent catheter ablation. Results are presented as mean difference (MD) with 95% confidence interval (CI). Heterogeneity was assessed with the I2 statistic, and outcomes are expressed as relative risk (RR). R software version 4.2.3 was used for the analysis.

RESULTS:

Three RCTs and one cohort study, comprising 642 patients with 319 patients in the S/V group and 323 in the control group, were included. Follow-up ranged from 6 to 36 months, with mean ages ranging from 58.9 to 65.8 years. A significant reduction in persistent AF occurrence was demonstrated favoring the S/V group (RR 0.54; 95% CI [0.41, 0.70]; p = 0.000004; I2 80%) over the ACEI/ARB group. There was no significant difference in left ventricular ejection fraction with S/V use (MD 1.23; 95% CI [-0.12, 2.60]; p = 0.076; I2 0%) compared with ACEI/ARB. The analysis also showed a significant reduction in left atrial volume index (MD -5.33; 95% CI [-8.76, -1.90]; p = 0.002; I2 57%) in the S/V group compared with the ACEI/ARB group.

CONCLUSION:

This meta-analysis demonstrated the efficacy of S/V in reducing the incidence of AF in patients undergoing catheter ablation compared with the use of ACEI/ARB. However, more RCTs are needed for a comprehensive evaluation of its efficacy in reducing AF recurrence after catheter ablation in clinical practice.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Idioma: En Revista: Herz Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Brasil País de publicação: Alemanha
Texto completo
Adicionar na Minha BVS
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Idioma: En Revista: Herz Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Brasil País de publicação: Alemanha