Skip to main content
SpringerLink
Log in

Evaluation of the Efficacy of Sacubitril/Valsartan on Radiofrequency Ablation in Patients with Hypertension and Persistent Atrial Fibrillation

  • Original Article
  • Published:
Cardiovascular Drugs and Therapy Aims and scope Submit manuscript

Abstract

Objective

To evaluate whether the effect of radiofrequency ablation can be improved by using sacubitril/valsartan (S/V) to control blood pressure in hypertensive patients with persistent atrial fibrillation.

Methods

A total of 63 and 67 hypertension patients with persistent atrial fibrillation were enrolled in an S/V group and ACEI/ARB group, respectively. All patients underwent radiofrequency catheter ablation (RFCA). The blood pressure of the two groups was controlled within the range of 100–140 mmHg (high pressure) and 60–90 mmHg (low pressure). The clinical outcomes of the two groups were observed after 12 months of follow-up.

Results

No significant differences in blood pressure were observed between the S/V and ACEI/ARB groups. In addition, the recurrence rate of atrial fibrillation between the two groups was not different. The left atrial diameter was an independent predictor of recurrence (HR = 1.063, P = 0.008). However, in the heart failure subgroup, the recurrence rate of S/V was significantly lower than that of the ACEI/ARB group (P = 0.005), and Cox regression analysis showed that the recurrence risk of atrial fibrillation of the S/V group was 0.302 lower than that of the ACEI/ARB group. NT-proBNP, LVEF, and LAD were significantly improved in hypertension patients with heart failure when comparing cases before and at the end of follow-up.

Conclusions

S/V is better than ACEI/ARB in reducing the recurrence of persistent atrial fibrillation in patients with hypertension and heart failure after RFCA.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Data Availability

Data are accessible or available upon request.

References

  1. Ruilope LM, Dukat A, Böhm M, Lacourcière Y, Gong J, Lefkowitz MP. Blood-pressure reduction with LCZ696, a novel dual-acting inhibitor of the angiotensin II receptor and neprilysin: a randomised, double-blind, placebo-controlled, active comparator study. Lancet. 2010;375(9722):1255–66.

    Article  CAS  PubMed  Google Scholar 

  2. Jackson AM, Jhund PS, Anand IS, Düngen HD, Lam CSP, Lefkowitz MP, et al. Sacubitril-valsartan as a treatment for apparent resistant hypertension in patients with heart failure and preserved ejection fraction. Eur Heart J. 2021;42(36):3741–52.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. January CT, Wann LS, Calkins H, Chen LY, Cigarroa JE, Cleveland JC Jr, et al. 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society in Collaboration With the Society of Thoracic Surgeons. Circulation. 2019;140(2):e125–51.

    Article  PubMed  Google Scholar 

  4. Lévy S, Steinbeck G, Santini L, Nabauer M, Maceda DP, Kantharia BK, et al. Management of atrial fibrillation: two decades of progress – a scientific statement from the European Cardiac Arrhythmia Society. J Interv Card Electrophysiol. 2022;65(1):287–326.

    Article  PubMed  Google Scholar 

  5. Di Biase L, Mohanty P, Mohanty S, Santangeli P, Trivedi C, Lakkireddy D, Reddy M, Jais P, Themistoclakis S, Dello Russo A, et al. Ablation versus amiodarone for treatment of persistent atrial fibrillation in patients with congestive heart failure and an implanted device: results from the AATAC multicenter randomized trial. Circulation. 2016;133:1637–44.

    Article  PubMed  Google Scholar 

  6. Marrouche NF, Brachmann J, Andresen D, Siebels J, Boersma L, Jordaens L, et al. Catheter ablation for atrial fibrillation with heart failure. N Engl J Med. 2018;378(5):417–27.

    Article  PubMed  Google Scholar 

  7. Sayed A, Awad AK, Abdelfattah OM, Elsayed M, Herzallah K, Marine JE, et al. The impact of catheter ablation in patient’s heart failure and atrial fibrillation: a meta-analysis of randomized clinical trials. J Interv Card Electrophysiol. 2023;66(6):1487–97.

    Article  PubMed  Google Scholar 

  8. Kuck KH, Merkely B, Zahn R, Arentz T, Seidl K, Schluter M, et al. Catheter ablation versus best medical therapy in patients with persistent atrial fibrillation and congestive heart failure: the randomized AMICA trial. Circ Arrhythm Electrophysiol. 2019;12:e007731.

    Article  PubMed  Google Scholar 

  9. Chen Q, Chen Y, Qin F, Du H, Gan C, Zhou B, et al. Effect of sacubitril-valsartan on restoration and maintenance of sinus rhythm in patients with persistent atrial fibrillation. Front Cardiovasc Med. 2022;9:870203.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Wang Q, Zhuo C, Xia Q, Jiang J, Wu B, Zhou D, et al. Sacubitril/valsartan can reduce atrial fibrillation recurrence after catheter ablation in patients with persistent atrial fibrillation. Cardiovasc Drugs Ther. 2023;37(3):549–60.

    Article  PubMed  Google Scholar 

  11. Liu J. Highlights of the 2018 Chinese hypertension guidelines. Clin Hypertens. 2020;26:8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Dong JZ, Sang CH, Yu RH, Long DY, Tang RB, Jiang CX, et al. Prospective randomized comparison between a fixed ‘2C3L’ approach vs. stepwise approach for catheter ablation of persistent atrial fibrillation. Europace. 2015;17(12):1798–806.

    Article  PubMed  Google Scholar 

  13. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Colvin MM, et al. 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Circulation. 2017;136(6):e137–61.

    Article  PubMed  Google Scholar 

  14. Kario K, Sun N, Chiang FT, Supasyndh O, Baek SH, Inubushi-Molessa A, et al. Efficacy and safety of LCZ696, a first-in-class angiotensin receptor neprilysin inhibitor, in Asian patients with hypertension: a randomized, double-blind, placebo-controlled study. Hypertension. 2014;63(4):698–705.

    Article  CAS  PubMed  Google Scholar 

  15. Madrid AH, Bueno MG, Rebollo JM, Marín I, Peña G, Bernal E, et al. Use of irbesartan to maintain sinus rhythm in patients with long-lasting persistent atrial fibrillation: a prospective and randomized study. Circulation. 2002;106(3):331–6.

    Article  CAS  PubMed  Google Scholar 

  16. Ueng KC, Tsai TP, Yu WC, Tsai CF, Lin MC, Chan KC, et al. Use of enalapril to facilitate sinus rhythm maintenance after external cardioversion of long-standing persistent atrial fibrillation. Results of a prospective and controlled study. Eur Heart J. 2003;24(23):2090–8.

    Article  CAS  PubMed  Google Scholar 

  17. Liu X, Liu H, Wang L, Zhang L, Xu Q. Role of sacubitril-valsartan in the prevention of atrial fibrillation occurrence in patients with heart failure: a systematic review and meta-analysis of randomized controlled trials. PLoS One. 2022;17(1):e0263131.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Li SN, Zhang JR, Zhou L, Xi H, Li CY, Zhao L. Sacubitril/valsartan decreases atrial fibrillation susceptibility by inhibiting angiotensin II-induced atrial fibrosis through p-Smad2/3, p-JNK, and p-p38 signaling pathways. J Cardiovasc Transl Res. 2022;15(1):131–42.

    Article  PubMed  Google Scholar 

  19. Li LY, Lou Q, Liu GZ, Lv JC, Yun FX, Li TK, et al. Sacubitril/valsartan attenuates atrial electrical and structural remodelling in a rabbit model of atrial fibrillation. Eur J Pharmacol. 2020;881:173120.

    Article  CAS  PubMed  Google Scholar 

  20. Suo Y, Yuan M, Li H, Zhang Y, Li Y, Fu H, et al. Sacubitril/valsartan improves left atrial and left atrial appendage function in patients with atrial fibrillation and in pressure overload-induced mice. Front Pharmacol. 2019;10:1285.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Yang L, Zhang M, Hao Z, Wang N, Zhang M. Sacubitril/valsartan attenuates atrial structural remodelling in atrial fibrillation patients. ESC Heart Fail. 2022;9(4):2428–34.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Schmieder RE, Wagner F, Mayr M, Delles C, Ott C, Keicher C, et al. The effect of sacubitril/valsartan compared to olmesartan on cardiovascular remodelling in subjects with essential hypertension: the results of a randomized, double-blind, active-controlled study. Eur Heart J. 2017;38(44):3308–17.

    Article  CAS  PubMed  Google Scholar 

  23. Desai AS, Solomon SD, Shah AM, Claggett BL, Fang JC, Izzo J, et al. Effect of sacubitril-valsartan vs enalapril on aortic stiffness in patients with heart failure and reduced ejection fraction: a randomized clinical trial. JAMA. 2019;322(11):1077–84.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. De Vecchis R, Paccone A, Di Maio M. Favorable effects of sacubitril/valsartan on the peak atrial longitudinal strain in patients with chronic heart failure and a history of one or more episodes of atrial fibrillation: a retrospective cohort study. J Clin Med Res. 2020;12(2):100–7.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Russo V, Bottino R, Rago A, Papa AA, Liccardo B, Proietti R, et al. The effect of sacubitril/valsartan on device detected arrhythmias and electrical parameters among dilated cardiomyopathy patients with reduced ejection fraction and implantable cardioverter defibrillator. J Clin Med. 2020;9(4):1111.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. de Diego C, González-Torres L, Núñez JM, CenturiónInda R, Martin-Langerwerf DA, Sangio AD, et al. Effects of angiotensin-neprilysin inhibition compared to angiotensin inhibition on ventricular arrhythmias in reduced ejection fraction patients under continuous remote monitoring of implantable defibrillator devices. Heart Rhythm. 2018;15(3):395–402.

    Article  PubMed  Google Scholar 

  27. Pan J, Xu C, Xu B, Lou Y, Wang S, Xing Y. Relationship between the time point of left atrial size change and the outcomes of radiofrequency catheter ablation. J Interv Card Electrophysiol. 2022;64(3):669–75.

    Article  PubMed  Google Scholar 

  28. Magnani S, Muser D, Chik W, Santangeli P. Adjunct ablation strategies for persistent atrial fibrillation-beyond pulmonary vein isolation. J Thorac Dis. 2015;7(2):178–84.

    PubMed  PubMed Central  Google Scholar 

  29. Kreidieh O, Varley AL, Romero J, Singh D, Silverstein J, Thosani A, et al. Practice patterns of operators participating in the Real-World Experience of Catheter Ablation for Treatment of Symptomatic Paroxysmal and Persistent Atrial Fibrillation (REAL-AF) Registry. J Interv Card Electrophysiol. 2022;65(2):429–40.

    Article  PubMed  Google Scholar 

  30. Dixit S, Marchlinski FE, Lin D, Callans DJ, Bala R, Riley MP, et al. Randomized ablation strategies for the treatment of persistent atrial fibrillation: RASTA study. Circ Arrhythm Electrophysiol. 2012;5(2):287–94.

    Article  PubMed  Google Scholar 

  31. Wu S, Li H, Yi S, Yao J, Chen X. Comparing the efficacy of catheter ablation strategies for persistent atrial fibrillation: a Bayesian analysis of randomized controlled trials. J Interv Card Electrophysiol. 2023;66(3):757–70.

    PubMed  Google Scholar 

  32. Weng W, Birnie DH, Ramirez FD, Van Stiphout C, Golian M, Nery PB, et al. Outcomes of a comprehensive strategy during repeat atrial fibrillation ablation. J Interv Card Electrophysiol. 2022;65(2):391–9.

    Article  PubMed  Google Scholar 

  33. Yamashita S, Tokuda M, Mahida S, Sato H, Ikewaki H, Oseto H, et al. Very long term outcome after linear versus electrogram guided ablation for persistent atrial fibrillation. Sci Rep. 2021;11(1):23591.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Funding

This work was supported by the Joint Construction Project of Henan Medical Science and Technology (LHGJ20210091), Science and Technology Project of Henan Province (222102310065), and Cuttingedge and Basic Research Project of Henan Province (122300410136).

Author information

Author notes

  1. Xiaobiao Zang and Zhihan Zhao contributed equally to this work.

Authors and Affiliations

  1. Department of Cardiology, People’s Hospital of Zhengzhou University (Henan Provincial People’s Hospital), Fuwai Central China Cardiovascular Hospital, No. 1 Fuwai Avenue, Zhengdong New District, Zhengzhou City, 451400, Henan Province, China

    Xiaobiao Zang, Zhihan Zhao, Ke Chen, Weifeng Song, Jifang Ma, You Zhou, Erpeng Liang, Haixia Fu, Xianqing Wang & Yonghui Zhao

  2. Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China

    Rongfeng Zhang

Authors
  1. Xiaobiao Zang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Zhihan Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ke Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Weifeng Song
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jifang Ma
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. You Zhou
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Erpeng Liang
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Haixia Fu
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Xianqing Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Yonghui Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Rongfeng Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conception and design of the study: Xiaobiao Zang, Zhihan Zhao, Yonghui Zhao, and Rongfeng Zhang. Data collection: Xiaobiao Zang, Zhihan Zhao, Ke Chen, Weifeng Song, Jifang Ma, You Zhou, and Erpeng Liang. Data analysis: Xiaobiao Zang, Haixia Fu, and Xianqing Wang. Manuscript writing: Xiaobiao Zang and Zhihan Zhao. Critical revision: Yonghui Zhao and Rongfeng Zhang. All authors have read and approved the final manuscript.

Corresponding authors

Correspondence to Yonghui Zhao or Rongfeng Zhang.

Ethics declarations

Ethics Approval and Consent to Participate

This study was approved by the Ethics Committee of Henan Provincial People’s Hospital. The protocol and consent form were approved by the institutional review board of the Henan Provincial People’s Hospital. All patients provided written informed consent for participation before study entry.

Consent for Publication

All authors reviewed the manuscript and approved its submission.

Conflict of Interest

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zang, X., Zhao, Z., Chen, K. et al. Evaluation of the Efficacy of Sacubitril/Valsartan on Radiofrequency Ablation in Patients with Hypertension and Persistent Atrial Fibrillation. Cardiovasc Drugs Ther (2023). https://doi.org/10.1007/s10557-023-07493-6

Download citation

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s10557-023-07493-6

Keywords

Search

Navigation