P303Effects of angiotensin-neprilysin inhibition as compared to angiotensin inhibition on ventricular arrhythmias in reduced ejection fraction patients under continuous remote monitoring of implantable de

Abstract

Background: Angiotensin-neprilysin inhibition as compared to angiotensin inhibition decreased sudden cardiac death in reduced ejection fraction heart failure (rEFHF). The precise mechanism remains unclear. Purpose: To explore the effect of angiotensin-neprilysin inhibition on ventricular arrhythmias as compared to angiotensin inhibition in rEFHF patients with an implantable cardiac defibrillator (ICD) and remote monitoring. Methods: We prospectively included 120 patients with ICD and: 1) New York Heart Association functional class II, 2) left ventricular ejection fraction (LVEF) 40%, 3) remote monitoring. For 9 months, patients received 100% angiotensin inhibition with angiotensin-converting-enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB), beta-blockers (BBK) and mineraloid antagonist (MRA). Subsequently, ACEi inhibitor or ARB was changed to Sacubitril-Valsartan in all patients, who were followed for 9 months analyzing: appropriate shocks, non-sustained ventricular tachycardia (NSVT), premature ventricular contraction burden (PVC) and biventricular pacing percentage. Results: Patients averaged an age of 6968 with a LVEF of 30.464 (82 % ischemic). The use of BBK (98%) or MRA (97%) or antiarrhythmic drugs was similar before and after Sacubitril-valsartan. Sacubitril-Valsartan significantly decreased NSVT episodes (5.460.5 vs. 15 61.7 in angiotensin inhibition, p < 0.002), sustained ventricular tachycardia and appropriate ICD shocks (0.8 % vs. 6.6% in angiotensin inhibition, p<0.02). PVC per hour decreased after Sacubitril-valsartan (33612 vs. 78 615 in angiotensin inhibition, p< 0.0003) associated to an increase of biventricular pacing percentage (from 9566 % to 98.861.3 %, p<0.02). Conclusions: Angiotensin-neprilysin inhibition decreased ventricular arrhythmias and appropriate ICDs shocks in rEFHF patients under home monitoring as compared to angiotensin inhibition.