Sacubitril/Valsartan in the Management of Heart Failure Patients with Cardiac Implantable Electronic Devices

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.