Objective  To systematically evaluate the efficacy and safety of sacubitril/valsartan (SV) in the treatment of atrial fibrillation(AF).

Methods  Computerized searches of PubMed, Embase, Web of Science, The Cochrane Library, CNKI, WanFang Data and VIP from the time of inception to April 27, 2024 were conducted. Literature screening, data extraction and quality assessment were conducted independently by two researchers. Meta-analysis was performed using RevMan 5.4 software.

Results  A total of 10 studies were included, including 8 randomized controlled trials, 2 cohort studies, with a cumulative total of 1 355 patients. The test group was treated with conventional therapy+SV, and the control group was treated with conventional therapy or conventional therapy+angiotensin converting enzyme inhibitor (ACEI)/angiotensin receptor blockers (ARB). The results of the Meta-analysis showed that in patients with AF who converted to sinus rhythm after undergoing radiofrequency catheter ablation, compared with the conventional therapy+ACEI/ARB, the conventional therapy+SV was able to significantly reduce the recurrence rate of AF [OR=0.35, 95%CI(0.26, 0.46), P<0.001], reduced left atrial diameter [MD=-3.26, 95%CI(-4.81, -1.70), P<0.001], and left atrial volume index[MD=-6.50, 95%CI(-8.76, -4.25), P<0.001], increase the level of left ventricle ejection fraction[MD=3.79, 95%CI(2.17, 5.41), P<0.001], decreased levels of N-terminal pro-brain natriuretic peptide [MD=-106.49, 95%CI(-134.71, -78.27), P<0.001], reduce the incidence of adverse drug reactions [OR=0.48, 95%CI(0.26, 0.86), P=0.01]. However, the efficacy in lowering blood pressure was similar in both groups.

Conclusion The application of conventional therapy+SV after ablation in patients with AF was more effective in reducing the recurrence rate of AF and improving left heart function compared with conventional therapy or conventional therapy+ACEI/ARB, while there was no significant difference in the magnitude of blood pressure reduction, this conclusion need to be justified by more high-quality research.

1.中华医学会心血管病学分会, 中国生物医学工程学会心律分会. 心房颤动诊断和治疗中国指南[J]. 中华心血管病杂志, 2023, 51(6): 572-618. [Chinese Society of Cardiology, Chinese Society of Biomedical Engineering. Chinese guidelines on diagnosis and management of atrial fibrillation[J]. Chinese Journal of Cardiology, 2013, 51(6): 572-618.] DOI: 10.3760/cma.j.cn112148-20230416-00221.

2.Zafeiropoulos S, Doundoulakis I, Bekiaridou A, et al. Rhythm vs rate control strategy for atrial fibrillation: a Meta-analysis of randomized controlled trials[J]. JACC Clin Electrophysiol, 2024, 10(7Pt1): 1395-1405. DOI: 10.1016/j.jacep.2024.03.006.

3.Jia R, Ji Y, Sun D. Progress and prospects of sacubitril/valsartan: based on heart failure with preserved ejection fraction[J]. Biomed Pharmacother, 2022, 155: 113701. DOI: 10.1016/j.biopha.2022.113701.

4.Guerra F, Pimpini L, Flori M, et al. Sacubitril/valsartan reduces atrial fibrillation and supraventricular arrhythmias in patients with HFrEF and remote monitoring: preliminary data from the SAVE THE RHYTHM[J]. Eur Heart J, 2020, 41(2): 926. DOI: 10.1093/ehjci/ehaa946.0926.

5.Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews[J]. BMJ, 2021, 372: n71. DOI: 10.1136/bmj.n71.

6.孙春玲, 吴进寿, 金哲秀, 等. 沙库巴曲缬沙坦钠联合胺碘酮对房颤射频消融术后患者心房重构及炎性因子的影响[J]. 中国现代药物应用, 2021, 15(24): 204-206. [Sun CL, Wu JS, Jin ZX, et al. Effect of sacubitril-valsartan sodium combined with amiodarone on atrial remodeling and inflammatory factors in patients with atrial fibrillation after radiofrequency ablation[J]. Chinese Journal of Modern Drug Application , 2021, 15(24): 204-206.] DOI: 10.14164/j.cnki.cn11-5581/r.2021.24.079.

7.黄琼, 刘荣, 陈立鸿, 等. 持续性心房颤动射频消融术后应用沙库巴曲缬沙坦的疗效分析[J]. 中华老年医学杂志, 2021, 40(7): 872-876. [Huang Q, Liu R, Chen LH, et al. Clinical effects of sacubitril/valsartan on persistent atrial fibrillation after catheter ablation[J]. Chinese Journal of Geriatrics, 2021, 40(7): 872-876.] DOI: 10.3760/cma.j.issn.0254-9026.2021.07.012.

8.李展. 房颤射频消融术联合沙库巴曲缬沙坦对持续性心房颤动患者心房重构的影响[J]. 中国科技期刊数据库医药, 2023, (10): 49-53. [Li Z. Effect of radiofrequency ablation of atrial fibrillation combined with sacubitril-valsartan on atrial remodeling in patients with persistent atrial fibrillation[J]. China Science and Technology Journal Database Medicine, 2023, (10): 49-53.] https://ersp.lib.whu.edu.cn/s/com/cqvip/qikan/G.http/Qikan/Article/Detail?id=1000003871966&from=Qikan_Search_Index

9.李伏, 段学波, 蒋庆军, 等. 沙库巴曲缬沙坦在房颤合并心衰射频消融术后患者中的应用效果观察 [J]. 医药前沿, 2023, 13(13): 87-89. [Li F, Duan XB, Jiang QJ, et al. Effect of sacubitril-valsartan in patients with atrial fibrillation complicated with heart failure after radiofrequency ablation[J]. Yiyao Qianyan , 2023, 13(13): 87-89.] DOI: 10.3969/j.issn.2095-1752.2023.13.027.

10.于璠, 朱雪峰, 仲琳,等. 沙库巴曲缬沙坦改善持续性心房颤动射频消融术后心脏结构与功能[J]. 内科急危重症杂志, 2022, 28(6): 482-486. [Yu F, Zhu XF, Zhong L, et al. Sacubitril-valsartan improves cardiac structure and function after radiofrequency ablation for the patients with persistent atrial fibrillation[J]. Journal of Internal Intensive Medicine, 2022, 28(6): 482-486.] DOI: 10.11768/nkjwzzzz20220611.

11.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[J]. Cardiovasc Drugs Ther, 2023, 7. DOI: 10.1007/s10557-023-07493-6.

12.Yang L, Zhang M, Hao Z, et al. Sacubitril/valsartan attenuates atrial structural remodelling in atrial fibrillation patients[J]. ESC Heart Fail, 2022, 9(4): 2428-2434. DOI: 10.1002/ehf2.13937.

13.Wang QQ, Zhuo CG, Xia Q, et al. Sacubitril/valsartan can reduce atrial fibrillation recurrence after catheter ablation in patients with persistent atrial fibrillation[J]. Cardiovasc Drugs Ther, 2023, 37(3): 549-560. DOI: 10.1007/s10557-022-07315-1.

14.Dong Y, Xiao S, He J, et al. Angiotensin receptor-neprilysin inhibitor therapy and recurrence of atrial fibrillation after radiofrequency catheter ablation: a propensity-matched cohort study[J]. Front Cardiovasc Med, 2022, 9: 932780. DOI: 10.3389/fcvm.2022.932780.

15.梁晓芳, 李文华, 宋艳斌, 等. 沙库巴曲缬沙坦对持续性心房颤动导管消融术后临床疗效的影响：基于倾向性评分的单中心队列研究[J]. 临床心血管病杂志, 2023, 39(9): 699-706. [Liang XF, Li WH, Song YB, et al. Effect of sacubitril/valsartan on clinical outcomes in patients with persistent atrial fibrillation undergoing catheter ablation: a single-center cohort study using propensity score matching[J]. Journal of Clinical Cardiology, 2023, 39(9): 699-706.] DOI: 10.13201/j.issn.1001-1439.2023.09.009.

16.Suo Y, Yuan M, Li H, et al. Sacubitril/valsartan improves left atrial and left atrial appendage function in patients with atrial fibrillation and in pressure overload-induced mice[J]. Front Pharmacol, 2019, 10: 1285. DOI: 10.3389/fphar.2019.01285.

17.Li LY, Lou Q, Liu GZ, et al. Sacubitril/valsartan attenuates atrial electrical and structural remodelling in a rabbit model of atrial fibrillation[J]. Eur J Pharmacol, 2020, 881: 173120. DOI: 10.1016/j.ejphar.2020.173120.

18.Li SN, Zhang JR, Zhou L, et al. 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]. J Cardiovasc Transl Res, 2022, 15(1): 131-142. DOI: 10.1007/s12265-021-10137-5.

19.Iwamiya S, Ihara K, Furukawa T, et al. Sacubitril/valsartan attenuates atrial conduction disturbance and electrophysiological heterogeneity with ameliorating fibrosis in mice[J]. Front Cardiovasc Med, 2024, 11: 1341601. DOI: 10.3389/fcvm.2024.1341601.

20.de Diego C, González-Torres L, Núñez JM, 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[J]. Heart Rhythm, 2018, 15(3): 395-402. DOI: 10.1016/j.hrthm.2017.11.012.

21.Sun Q, Cui W, Zhang X, et al. A systematic review and Meta-analysis of renin-angiotensin system inhibitors and angiotensin receptor neprilysin inhibitors in preventing recurrence after atrial fibrillation ablation[J]. J Cardiovasc Pharmacol, 2024, 83(3): 220-227. DOI: 10.1097/FJC.0000000000001517.

22.Wang R, Ye H, Ma L, et al. Effect of sacubitril/valsartan on reducing the risk of arrhythmia: a systematic review and Meta-analysis of randomized controlled trials[J]. Front Cardiovasc Med, 2022, 9: 890481. DOI: 10.3389/fcvm.2022.890481.

23.Mohammad Z, Ahmad J, Sultan A, et al. Effect of sacubitril-valsartan on the incidence of atrial fibrillation: a Meta-analysis[J]. J Cardiovasc Electrophysiol, 2023, 34(4): 1037-1042. DOI: 10.1111/jce.15880.

24.Liu X, Liu H, Wang L, et al. 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[J]. PLoS One, 2022, 17(1): e0263131. DOI: 10.1371/journal.pone.0263131.

25.张占欣, 高学英, 王帅, 等. 沙库巴曲缬沙坦治疗心房颤动的有效性和安全性: 荟萃分析及系统综述[J]. 中华心律失常学杂志, 2023, 27(1): 44-50. [Zhang ZX, Gao XY, Wang S, et al. Efficacy and safety of sacubitril-valsartan in patients with atrial fibrillation: a Meta analysis and systematic review[J].Chinese Journal of Cardiac Arrhythmias, 2023, 27(1): 44-50.] DOI: 10.3760/cma.j.cn113859-20220508-00090.