Effect Of Sacubitril-valsartan On Short-term Outcome In Patients With Persistent Atrial Fibrillation Who Underwent Electrical Cardioversion

Objective: We aimed to evaluate whether sacubitril-valsartan,an angiotensin receptor neprilysin inhibitor(ARNI),could result in a lower rate of failed electrical cardioversion(ECV)in patients with persistent atrial fibrillation(AF).Method: Consecutive patients with persistent AF who underwent ECV between January 1,2016 and September 30,2020 were investigated in this single-centre,retrospective cohort study.All eligible patients were divided into sacubitril-valsartan users(ARNI group)and sacubitril-valsartan non-users(non-ARNI group)based on whether they received treatment with sacubitril-valsartan or not.The endpoint was failed ECV,defined as the composite of failure to terminate AF or any recurrence of AF during a 30 days follow-up.Results: A total of 76 patients were enrolled in this study,including 28 in ARNI group and 48 in non-ARNI group.After a follow-up of 30 days,the endpoint had occurred in 7(25.0%)patients of ARNI group and 25(52.1%)patients of non-ARNI group,respectively.A significantly lower rate of failed ECV in ARNI group compared with non-ARNI group was shown in Kaplan-Meier survival curves(P=0.015).Multivariate Cox regression analysis indicated that sacubitril-valsartan use(HR 0.34,95%CI 0.14-0.82),amiodarone use(HR 0.41,95%CI 0.18-0.94),left atrial diameter≤39mm(HR=0.21,95%CI 0.06-0.68)were independent factors for failed ECV.Conclusion: Use of sacubitril-valsartan is associated with a significantly decreased risk of failed ECV compared with non-users in patients with persistent AF.