Efficacy of Sacubitril-Valsartan Compared with Angiotensin-Converting Enzyme Inhibitor or Angiotensin-Receptor Blocker for Preventing Atrial Fibrillation Recurrence After Catheter Ablation: A Systematic Review and Meta-Analysis AHA Conference Repository

American Heart Association

Final ID: Mo2133

Efficacy of Sacubitril-Valsartan Compared with Angiotensin-Converting Enzyme Inhibitor or Angiotensin-Receptor Blocker for Preventing Atrial Fibrillation Recurrence After Catheter Ablation: A Systematic Review and Meta-Analysis

Abstract Body (Do not enter title and authors here):
INTRODUCTION: In patients who have undergone catheter ablation due to atrial fibrillation (AF), recurrence of this condition can occur. The effect of Sacubitril/Valsartan (S/V) on preventing atrial fibrillation recurrence compared to Angiotensin-Converting Enzyme Inhibitor (ACEI) or Angiotensin II Receptor Blocker (ARB) is not established. This meta-analysis aims to establish the best therapeutic choice for preventing AF recurrence after catheter ablation.
METHOD: A systematic search was conducted in PubMed, Embase, and Cochrane databases for randomized clinical trial (RCT) and observational studies comparing the use of S/V with ACEI/ARB in patients who underwent catheter ablation. Results were presented as mean differences (MD) with a 95% confidence interval (CI). Heterogeneity was assessed by I2, and outcomes were expressed as relative risks (RR), using R software version 4.2.3.
RESULTS: Three randomized clinical trials 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 to 0.70; P=0.000004; I2: 80%) compared to the ACEI/ARB group. The analysis also showed a significant reduction in Left Atrial Volume Index (LAVI) (MD: -5.33; 95% CI: -8.76 to -1.90; P=0.002; I2: 57%) in the S/V group compared to ACEI/ARB. There was no significant difference in left ventricular ejection fraction (LVEF) with S/V use (MD: 1.23; 95% CI: -0.12 to 2.60; P=0.076; I2: 0%) compared to ACEI/ARB.
CONCLUSION: This meta-analysis demonstrated the efficacy of S/V in reducing the incidence of AF in patients undergoing catheter ablation compared to the use of ACEI/ARB. However, more randomized clinical trials are needed for a comprehensive evaluation of its efficacy in reducing AF recurrence in post-catheter ablation patients in clinical practice.

Bezerra, Fernando ( Anhembi Morumbi University , São José dos Campos , SP , Brazil )
Rocha Dantas, Clara ( Universidad de Buenos Aires , Buenos Aires , Argentina )
Sobreira, Luis ( Federal University of Pará , Altamira , Brazil )
Kendi Tsuchiya Sano, Vitor ( Federal University of Acre , Rio Branco , Brazil )
De Oliveira Macena Lobo, Artur ( Federal University of Pernambuco , Recife , Brazil )
Cardoso, Jorge ( University of Pernambuco, , Recife , Brazil )
Kelly, Francinny ( Dante Pazzanese Cardiology Institute , Sao Paulo , Brazil )
A De Moraes, Francisco Cezar ( Federal University of Para , Recife , Brazil )
Consolim Colombo, Fernanda ( Heart Institute , Sao paulo , Brazil )

Author Disclosures:

FERNANDO BEZERRA: