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Meta-Analysis
. 2025 Mar;25(2):157-167.
doi: 10.1007/s40256-024-00691-z. Epub 2024 Oct 29.

Sacubitril-Valsartan Lowers Atrial Fibrillation Recurrence and Left Atrial Volume Post-catheter Ablation: Systematic Review and Meta-Analysis

Larissa Araújo de Lucena  1 , Marcos Aurélio Araújo Freitas  2 , Camila Mota Guida  3 , Larissa C Hespanhol  4 , Ana Karenina C de Sousa  5 , Júlio César V de Sousa  5 , Ferdinand Gilbert S Maia  5
Affiliations
Meta-Analysis

Sacubitril-Valsartan Lowers Atrial Fibrillation Recurrence and Left Atrial Volume Post-catheter Ablation: Systematic Review and Meta-Analysis

Larissa Araújo de Lucena et al. Am J Cardiovasc Drugs. 2025 Mar.

Abstract

Introduction: In patients with atrial fibrillation (AF) who have undergone catheter ablation, the comparative effectiveness of sacubitril-valsartan (SV) versus ACE inhibitors (ACEi) or angiotensin-receptor blockers (ARB) in preventing AF recurrence remains unclear. The purpose of the present systematic review and meta-analysis is to determine whether SV offers superior outcomes in this clinical setting.

Methods: This study systematically reviewed PubMed, Embase, and the Cochrane Library for randomized controlled trials (RCTs) and propensity-matched cohorts (PMC), evaluating SV's efficacy in preventing AF recurrence after catheter ablation. Outcomes included AF recurrence and structural remodeling assessed via left ventricular ejection fraction (LVEF) and left atrial volume index (LAVi), with statistical analyses performed using Review Manager 5.1.7 and heterogeneity assessed via I2 statistics.

Results: The analysis comprised 642 patients from three RCTs and one PMC (319 SV-treated). SV significantly reduced AF recurrence [risk ratios (RR) 0.54; 95% confidence intervals (CI) 0.41-0.70; p < 0.00001; I2 = 0%), a trend also observed when considering RCTs exclusively (RR 0.58; 95% CI 0.41-0.84; p = 0.004; I2 = 0%). Moreover, SV demonstrated a notable reduction in LAVi [mean deviation (MD) -5.34 mL/m2; 95% CI -8.77 to -1.91; p = 0.002; I2 = 57%] compared with ARB, alongside a significant improvement in LVEF (MD 1.83%; 95% CI 1.35-2.32; p < 0.00001; I2 = 0%). Subgroup analyses among patients with hypertension and LVEF < 50% also indicated lower AF recurrence with SV.

Conclusion: SV therapy exhibited superior efficacy in reducing AF recurrence compared with ACEi or ARB and demonstrated superior outcomes in attenuating atrial structural remodeling after catheter ablation. These findings underscore the potential of SV as a therapeutic option for patients with AF undergoing catheter ablation, highlighting its efficacy in mitigating AF recurrence and structural remodeling.

Registration: PROSPERO identifier number CRD42024497958.

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Conflict of interest statement

Declarations. Funding: No external funding was used in the preparation of this manuscript. Conflict of Interest: Larissa Lucena, Marcos Aurélio Freitas, Camila Guida, Larissa Hespanhol, Ana Karenina Sousa, Júlio César Sousa, and Ferdinand Gilbert Maia declare that they have no potential conflicts of interest that might be relevant to the contents of this manuscript. Ethics Approval: Not required. Consent to Participate: Not applicable. Consent for Publication: Not applicable. Data Availability: Data used in the analysis are presented in tables and figures. The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request. Code Availability: Not applicable. Authors’ Contributions: L.L.: conceptualization, data curation, analysis, methodology, and writing. M.F. and C.G.: investigation, supervision, validation, reviewing, and editing. L.H. and A.S.: supervision, validation, reviewing, and editing. J.S. and F.M.: methodology, supervision, validation, reviewing, and editing.

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