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Sacubitril/Valsartan in the Management of Heart Failure Patients with Cardiac Implantable Electronic Devices

American Journal of Cardiovascular Drugs volume 21, pages 383–393 (2021)Cite this article

Abstract

For heart failure patients with cardiac implantable electronic devices (CIEDs), especially those who remain symptomatic after implantation, the best management strategy is still unclear. Although there are several concerns regarding the clinical utilization of sacubitril/valsartan, it has improved the prognosis of patients with heart failure compared with the use of renin-angiotensin system inhibitors in recent years. Recent real-world observational studies and post hoc analyses demonstrated that sacubitril/valsartan might have effects in patients with CIEDs. Given its potential underlying mechanisms, sacubitril/valsartan could improve outcomes of mortality and sudden cardiac death incidence, as well as clinical and echocardiographic evaluations. The possible antiarrhythmic effect of sacubitril/valsartan is still debated. Moreover, given that hypotension is the critical limitation of uptitration, the rise in systolic blood pressure attributed to cardiac resynchronization therapy might support the use of sacubitril/valsartan, with improved tolerance. The clinical utility of sacubitril/valsartan in heart failure patients with CIEDs requires further investigation to determine the actual effects, optimal target populations, and underlying mechanisms.

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  1. State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 North Lishi Road, Beijing, 100037, China

    Sijing Cheng, Nixiao Zhang & Wei Hua

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All authors contributed to the study conception and read and approved the final manuscript. Study conception and design: NZ and WH. Literature search and data analysis: SC and NZ. First draft of manuscript: SC and NZ. Critical revision: WH.

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Cheng, S., Zhang, N. & Hua, W. Sacubitril/Valsartan in the Management of Heart Failure Patients with Cardiac Implantable Electronic Devices. Am J Cardiovasc Drugs 21, 383–393 (2021). https://doi.org/10.1007/s40256-020-00448-4

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