Abstract
INTRODUCTION: Antiarrhythmic effects of sacubitril/valsartan in heart failure (HF) have been previously reported; however, its impact among individuals with ventricular arrhythmias with cardiac defibrillators remains unclear. Therefore, we performed this systematic review and meta-analysis to address this lack of evidence. METHOD: A systematic search of PubMed, Embase, and Cochrane Library was conducted from inception until February 26, 2025. Binary and continuous variables were analyzed by odds ratio (OR) and mean differences, respectively. All analyses were performed using a random-effects model by RevMan. RESULTS: Four paired observational cohort studies, including 397 patients with HF and implanted cardiac defibrillators (ICDs) were enrolled. This study showed that sacubitril/valsartan could significantly reduce the incidence of ICD shocks (OR, 0.33; 95% CI, 0.19 to 0.60; p = 0.0003; I (2) = 13%), appropriate ICD shocks (OR, 0.21; 95% CI, 0.10 to 0.47; p = 0.0001; I (2) = 0%), NSVT duration (OR, -1.86; 95% CI, -3.43 to -0.30; p = 0.02; I(2) = 86%), and biventricular (Biv) pacing < 90% (OR, 0.15; 95% CI, 0.03 to 0.83; p = 0.03; I (2) = 0%). However, the mata-analysis didn't reveal a significant association between sacubitril/valsartan and a lower rate of ventricular arrhythmia, sustained ventricular tachycardia (SVT), non-sustained ventricular tachycardia (NSVT), inappropriate ICD shocks, premature ventricular contractions per hour (PVC/h), and left ventricular ejection fraction (LVEF). CONCLUSION: Sacubitril/valsartan may have a potential benefit among HF patients with cardiac defibrillators; future investigations are warranted to confirm the antiarrhythmic effects of sacubitril/valsartan in this setting.