Ventricular arrhythmias and ARNI: is it time to reappraise their management in the light of new evidence?
Andrea Lorenzo VecchiRaffaele AbeteJacopo MarazzatoAttilio IacovoniAndrea MortaraRoberto De PontiMichele SenniPublished in: Heart failure reviews (2020)
The remarkable scientific progress in the treatment of patients with heart failure (HF) and reduced ejection fraction (HFrEF) has more than halved the risk of sudden cardiac death (SCD) in this setting. However, SCD remains one of the major causes of death in this patient population. Beyond the acknowledged role of beta blockers and inhibitors of the renin-angiotensin-aldosterone system (RAAS), a new class of drugs, the angiotensin receptor neprilysin inhibitors (ARNI), proved to reduce the overall cardiovascular mortality and, more specifically, the risk of SCD in HFrEF patients. The mechanism by which ARNI may reduce the mortality connected with harmful ventricular arrhythmias is not utterly clear. A variety of direct and indirect mechanisms have been suggested, but a favorable left ventricular reverse remodeling seems to play a key role in this setting. Furthermore, the well-known protective effect of implantable cardioverter-defibrillator (ICD) has been debated in HFrEF patients with non-ischemic cardiomyopathy (NICM) arguing against the role of primary prevention ICD in this setting, particularly when ARNI therapy is considered. The purpose of this review was to provide insights into the SCD mechanisms involved in HFrEF patients together with the current role of electrical therapies and new drug agents in this setting. Graphical abstract.
Keyphrases
- left ventricular
- end stage renal disease
- heart failure
- newly diagnosed
- chronic kidney disease
- ejection fraction
- angiotensin converting enzyme
- angiotensin ii
- peritoneal dialysis
- cardiovascular events
- stem cells
- acute myocardial infarction
- case report
- emergency department
- coronary artery disease
- mitral valve
- type diabetes
- acute coronary syndrome
- patient reported outcomes
- ischemia reperfusion injury
- mesenchymal stem cells
- blood brain barrier
- percutaneous coronary intervention
- hypertrophic cardiomyopathy
- aortic valve
- bone marrow
- oxidative stress
- congenital heart disease
- smoking cessation
- adverse drug