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Sacubitril/Valsartan Can Reduce Atrial Fibrillation Recurrence After Catheter Ablation in Patients with Persistent Atrial Fibrillation

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Abstract

Purpose

This study compared the effectiveness of sacubitril/valsartan (SV) vs. valsartan (V) for treating persistent atrial fibrillation (AF) after radio-frequency catheter ablation (RFCA).

Methods

Patients with persistent AF who received RFCA were randomly assigned to the SV or V treatment group with the intervention lasting for 12 months. The primary outcome included any atrial arrhythmia episode lasting ≥ 30 s after a 3-month blanking period. The secondary outcome included any atrial arrhythmia episode lasting ≥ 24 h or requiring cardioversion after a 3-month blanking period. The H2FPEF score was used to assess the possibility of patients suffering from heart failure with preserved ejection fraction.

Results

A total of 143 patients with persistent AF who received RFCA were randomized for the study, with 5 patients failing to follow-up. Among them, 29 (42%) out of 69 patients receiving V and 15 (21.7%) out of 69 patients receiving SV reached the primary endpoint (P < 0.001). A total of 26 (37.7%) out of 69 patients receiving V and 7 (10.1%) out of 69 patients receiving SV reached the secondary endpoint (P < 0.001). A decrease in the H2FPEF score after a 1-year follow-up seemed to be related to the recurrence of AF (OR, 0.065; 95% CI: 0.018–0.238, P < 0.001).

Conclusions

SV can decrease AF recurrence after catheter ablation in patients with persistent AF at the 1-year follow-up. The mechanism for this process may be related to the reduction in the H2FPEF score in patients with preserved ejection fraction heart failure.

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Data Availability

Data will be made available on reasonable request.

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Funding

This study was supported by the National Key R&D Program of China (Grant no. 2016YFC1301003), the National Science Foundation of China (Grant nos. 30900612, 81800231, and 81873484), the Clinical Research Fund of Zhejiang Provincial Medical Association (2015ZYC-A16 and 2018ZYC-A11), the Nature Science Foundation of Zhejiang Province (Grant no. LZ16H020001), the grant of Medical Science Research Foundation of Zhejiang Province (Grant no. 2018ZD017), grants from the Zhejiang Provincial Natural Science Foundation (Grant no. LY15H020002 and Y17H020020), and a grant from the Department of Science and Technology, Zhejiang Province (Grant no. LGF19H020011), People’s Republic of China.

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Author notes

  1. Qiqi Wang and Chengui Zhuo have contributed equally to this work.

Authors and Affiliations

  1. Department of Cardiology and Atrial Fibrillation Center, The First Affiliated HospitalCollege of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, Zhejiang Province, People’s Republic of China

    Qiqi Wang, Jiajia Jiang, Bifeng Wu, Dongchen Zhou, Jianqiang Zhao, Miao Chen, Heng Chen, Zewei Sun, Biqi Zhang, Jie Han & Liangrong Zheng

  2. Department of Cardiology, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, Zhejiang, 318000, People’s Republic of China

    Chengui Zhuo

  3. State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, Zhejiang Province, People’s Republic of China

    Qi Xia

  4. Department of Hepatobiliary Surgery, The First Affiliated HospitalCollege of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, Zhejiang Province, People’s Republic of China

    Zheyue Shu

Authors
  1. Qiqi Wang
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  2. Chengui Zhuo
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  3. Qi Xia
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  11. Zewei Sun
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  13. Jie Han
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  14. Liangrong Zheng
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Contributions

Liangrong Zheng, Qiqi Wang, Qi Xia, and Jie Han conceived the study. Qiqi Wang, Chengui Zhuo, and Zewei Sun designed the study. Jiajia Jiang and Jianqiang Zhao drafted the paper. Bifeng Wu, Dongchen Zhou, and Zheyue Shu collected the data. Miao Chen, Heng Chen, and Biqi Zhang analyzed and interpreted the data. All authors provide comments on the draft. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Liangrong Zheng.

Ethics declarations

Ethics Approval

The institutional review boards at Zhejiang University (Hangzhou, Zhejiang Province, China) approved the review of these data. The study was registered at http://www.chictr.org.cn (identifier: ChiCTR-TRC- 2000034257).

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All authors agree to publish.

Informed Consent

Informed consent was obtained from all patients included in the study.

Conflict of Interest

The authors declare no competing interests.

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Wang, Q., Zhuo, C., Xia, Q. et al. Sacubitril/Valsartan Can Reduce Atrial Fibrillation Recurrence After Catheter Ablation in Patients with Persistent Atrial Fibrillation. Cardiovasc Drugs Ther 37, 549–560 (2023). https://doi.org/10.1007/s10557-022-07315-1

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