State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 North Lishi Road, Beijing, 100037, China.
Am J Cardiovasc Drugs. 2021 Jul;21(4):383-393. doi: 10.1007/s40256-020-00448-4. Epub 2020 Oct 28.
For heart failure patients with cardiac implantable electronic devices (CIEDs), especially those who remain symptomatic after implantation, the best management strategy is still unclear. Although there are several concerns regarding the clinical utilization of sacubitril/valsartan, it has improved the prognosis of patients with heart failure compared with the use of renin-angiotensin system inhibitors in recent years. Recent real-world observational studies and post hoc analyses demonstrated that sacubitril/valsartan might have effects in patients with CIEDs. Given its potential underlying mechanisms, sacubitril/valsartan could improve outcomes of mortality and sudden cardiac death incidence, as well as clinical and echocardiographic evaluations. The possible antiarrhythmic effect of sacubitril/valsartan is still debated. Moreover, given that hypotension is the critical limitation of uptitration, the rise in systolic blood pressure attributed to cardiac resynchronization therapy might support the use of sacubitril/valsartan, with improved tolerance. The clinical utility of sacubitril/valsartan in heart failure patients with CIEDs requires further investigation to determine the actual effects, optimal target populations, and underlying mechanisms.
对于植入心脏植入式电子设备（CIED）的心力衰竭患者，尤其是那些植入后仍有症状的患者，最佳管理策略仍不清楚。尽管 sacubitril/valsartan 的临床应用存在一些担忧，但近年来它已改善了心力衰竭患者的预后，优于肾素-血管紧张素系统抑制剂的应用。最近的真实世界观察性研究和事后分析表明， sacubitril/valsartan 可能对 CIED 患者有疗效。鉴于其潜在的作用机制， sacubitril/valsartan 可能改善死亡率和心脏性猝死发生率以及临床和超声心动图评估的结果。 sacubitril/valsartan 的可能抗心律失常作用仍存在争议。此外，由于低血压是滴定的关键限制，心脏再同步治疗引起的收缩压升高可能支持使用 sacubitril/valsartan，以提高耐受性。 sacubitril/valsartan 在 CIED 心力衰竭患者中的临床应用需要进一步研究以确定实际效果、最佳目标人群和潜在机制。
