Angiotensin Receptor Neprilysin Inhibition in Heart Failure: Clinical Benefits and Antiarrhythmic Actions
DOI:
https://doi.org/10.5281/zenodo.14572251Keywords:
Angiotensin receptor neprilysin inhibition; ARNI; arrhythmia; heart failure; LCZ696; sacubitril; valsartan.Abstract
Inhibition of renin– angiotensin–aldosterone system and sympathetic nervous system are crucial for the treatment of HF with reduced ejection fraction (HFrEF). Modulation of the natriuretic system through inhibition of the enzyme that degrades natriuretic peptides, neprilysin, has proven to be successful too. Sacubitril/valsartan (LCZ696) is a first-in-class medicine of angiotensin receptor neprilysin inhibitor (ARNI) that contains a neprilysin inhibitor (sacubitril) and an angiotensin receptor blocker (valsartan). PARADIGM-HF trial demonstrated that morbidity and mortality can be improved with the use of ARNI. Furthermore, recent studies revealed that ARNI reduces sudden death, implantable cardioverter defibrillator shocks, premature ventricular contractions and cardiovascular mortality. Despite the increase in understanding of how ARNI favorably affects the arrhythmic outcomes, several key aspects are still not fully understood. This review will overview mechanism of action and use of ARNI in HFrEF; summarize data regarding antiarrhythmic action and clinical implications.
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