AUTHOR=Chen Qingsong , Chen Yunlin , Qin Fang , Du Huaan , Gan Chunxia , Zhou Bei , Wang Na , Xiao Mingyang , Ou Zhenhong , Zhao Wei , Cui Ben , Liu Zengzhang , Yin Yuehui 

TITLE=Effect of Sacubitril-Valsartan on Restoration and Maintenance of Sinus Rhythm in Patients With Persistent Atrial Fibrillation

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.870203

DOI=10.3389/fcvm.2022.870203

ISSN=2297-055X

ABSTRACT=Background: Existing studies have shown that sacubitril-valsartan ameliorated atrial remodeling in atrial fibrillation (AF) and favored maintenance of sinus rhythm in patients with AF and heart failure. However, the effect of sacubitril-valsartan in patients with persistent AF is yet unknown. We aimed to evaluate the effect of sacubitril-valsartan on restoration and maintenance of sinus rhythm in patients with persistent AF who underwent electrical cardioversion (ECV). 
Method: Consecutive patients with persistent AF who underwent ECV between January 1, 2016 and September 30, 2020 were investigated in this retrospective cohort study. All eligible patients were categorised into sacubitril-valsartan users and sacubitril-valsartan non-users based on whether they received treatment with sacubitril-valsartan or not. The endpoint was ineffictive ECV, defined as the composite of failure to terminate AF or any recurrence of AF during 30 days follow-up.
Results: A total of 76 patients were enrolled in this study, including 28 sacubitril-valsartan users and 48 non-users. Within a follow-up of 30 days after ECV, the endpoint had occurred in 7 (25%) of 28 sacubitril-valsartan users and 25 (52%) of 48 non-users. Significantly lower rate of ineffictive ECV in sacubitril-valsartan users compared with non-users was shown in Kaplan-Meier survival curves (P = 0.02; Log-rank test). Multivariate Cox regression analysis indicated that sacubitril-valsartan use (hazard ratio [HR], 0.35; 95% confidence interval [CI], 0.14-0.91), amiodarone use (HR, 0.32; 95% CI, 0.13-0.78), left atrial diameter ≤ 39 mm (HR, 0.21; 95% CI, 0.06-0.71) were independently associated with a decreased rate of ineffective electrical cardioversion.
Conclusion: Use of sacubitril-valsartan is associated with a significantly decreased risk of ineffictive ECV compared with non-users in patients with persistent AF.