Efficacy of Sacubitril/Valsartan Among Heart Failure Individuals With Implanted Cardiac Defibrillators: A Systematic Review and Meta‐Analysis

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; I² = 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.

This meta‐analysis suggested that sacubitril/valsartan could significantly reduce the incidence of ICD shocks, NSVT duration andBiv pacing < 90% among patients with heart failure and ICD. Evidence for ventricular arrhythmia reduction, PVC/h, and improvement in LVEF remains unclear due to short follow‐up and a limited number of studies.

1. Introduction

Ventricular tachycardia (VT) and ventricular fibrillation (VF) are the main causes of sudden cardiac death in the United States (US), resulting in an estimated 300 000 deaths annually [1, 2]. Notably, VT is responsible for approximately half of the deaths related to cardiac causes [2]. Research indicates a strong association between VT and coronary artery disease (CAD), with approximately 15% of patients with CAD exhibiting VT [3].

Sacubitril/valsartan is an angiotensin receptor–neprilysin inhibitor (ARNI), recommended for the treatment of individuals with heart failure (HF) by the American College of Cardiology/American Heart Association (ACC/AHA) guideline, and can reduce the risk of cardiovascular death and hospitalization due to HF in patients with chronic HF [4].

Several meta‐analyses have been conducted to describe the effects of sacubitril/valsartan on arrhythmia in the long term. A recent meta‐analysis, with 16 randomized clinical trials (RCTs) included 2200 patients with HF and reduced ejection fraction (HFrEF), demonstrated that sacubitril/valsartan significantly reduced the risk of severe arrhythmias, cardiac arrest, and VT [5].

Beyond the promising antiarrhythmic effects of sacubitril/valsartan in the setting of HF, it remains unclear whether this medication provide potential benefits in HF individuals with ventricular arrhythmias and cardiac defibrillators. Therefore, we aimed to conduct this systematic review and meta‐analysis. To our knowledge, this is the first systematic review and meta‐analysis that specifically focusing on HF patients receiving sacubitril/valsartan with ventricular arrythmias and cardiac defibrillators.

2. Method

The current systematic review and meta‐analysis were conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines [6]. Additionally, it was registered before its inception in the International Prospective Register of Systematic Reviews (PROSPERO) with registration number: CRD420251003369 [7].

2.1. Search Strategy

A systematic literature search was conducted in the PubMed, Embase, and Cochrane Library databases from inception till February 26, 2025, to identify relevant studies on the topic. The search strategy involved combining keywords as follows: ‘(“accelerated idioventricular rhythm” OR “tachycardia, heart ventricle” OR “tachycardia, ventricular” OR “ventricle tachycardia” OR “ventricular tachyarrhythmia” OR “ventricular tachycardia”) AND (“sacubitril plus valsartan” OR “3 (1 biphenyl 4 ylmethyl 3 ethoxycarbonyl 1 butylcarbamoyl) propionic acid plus valsartan” OR “entresto” OR “lcz 696” OR “valsartan plus sacubitril” OR “valsartan/sacubitril” OR “sacubitril/valsartan”)’. In addition, a manual inspection of reference lists from selected articles was also performed to capture any relevant studies that may have been missed by the initial search strategy. No language restriction was applied.

2.2. Study Selection and Data Extraction

In the process of screening literature, two independent reviewers (S.S. and H.A.) reviewed the related articles, and any disagreements that arose during this process were resolved with the corresponding author (T.E.). To ensure clear definitions and a structured approach, we utilized the PICO method including Population; HF, Intervention; sacubitril/valsartan, Comparison; control group, and Outcome; rate of VT, VF, Sustained Ventricular Tachycardia (SVT), non‐sustained Ventricular Tachycardia (NSVT), Left Ventricular Ejection Fraction (LVEF), Biventricular (Biv) pacing < 90%, and premature ventricular contraction per hour (PVC/h) to establish both the inclusion and exclusion criteria and create the concept map. The eligible trials were all clinical studies that evaluated the effects of sacubitril/valsartan among HF individuals with ventricular arrhythmias and cardiac defibrillators. Animal studies, case reports, case series, clinical research protocols, practice guidelines, reviews, meta‐analyses, book chapters, editorial or commentary publications, and in silico and in vitro studies, as well as duplicate articles, were all excluded in this process. Data on the specified variables, including the first author's name, year of publication, study design, follow‐up period, intervention, sample size, patient characteristics, and outcomes, were extracted independently by two authors, S.S. and H.A. These data were then checked by the corresponding author, T.E.

In our meta‐analysis, we defined arrhythmia outcomes (VT, NSVT, SVT) based on included studies. Two studies explicitly defined these outcomes, describing SVT as episodes lasting > 30 s and NSVT as > 4 consecutive ventricular beats lasting < 30 s. The remaining studies did not provide explicit definitions; however, they reported arrhythmia outcomes consistent with standard ICD/CRT device–based definitions, ensuring comparability across studies. We used the composite ventricular arrhythmia outcomes reported by each study, which included events such as VF, VT, SVT, and NSVT, depending on what each study reported. These outcomes were pooled under the broader category of ventricular arrhythmias to maintain consistency in data synthesis.

2.3. Risk of Bias Assessment

The risk of bias assessment in this evaluation was conducted according to the guidelines outlined in the Cochrane Handbook for Systematic Reviews of Interventions 5.1.0, published by The Cochrane Collaboration in 2011. The recommended risk of bias tool utilized in this assessment is the Cochrane ROBINS‐I [8]. We have categorized the risk of bias into three levels: low, moderate, and high. A visual representation of the results has been created using the Risk‐of‐Bias Visualization (robvis) tool [9].

2.4. Statistical Analysis

In this meta‐analysis, the binary variables were analyzed by using odds ratios (OR), and continuous variables, as means and standard deviations (SD) were calculated by mean differences. All analyses were evaluated using a random‐effects model with the Mantel–Haenszel method for statistical pooling. Risk estimates were calculated with 95% confidence intervals (CIs) using RevMan 5.2, as provided by The Cochrane Collaboration (The Nordic Cochrane Centre, Copenhagen, Denmark). To assess heterogeneity, we used the I ² statistic and referenced the heterogeneity interpretation guide from the Cochrane Handbook for systematic reviews of interventions, which categorizes heterogeneity as follows: 0%–25%: not important, 25%–50%: moderate, 50%–75%: substantial, and 75%–100%: considerable [10]. This meta‐analysis' results were evaluated using the GRADE approach to assess the level of evidence. Based on this approach, evidence was graded as high, moderate, low, or very low.

3. Results

3.1. Results of Screening Studies

Totally, 739 references were obtained through literature searching in Embase (n = 658), PubMed (n = 64), Cochrane Library (n = 12) and searching other references (n = 5). The eligibility assessment included 23 studies, which were removed after duplicates and screening records were reviewed by title and abstract. The reasons for exclusion of 19 records were as follows: irrelevant (n = 11), review/systematic review and meta‐analysis (n = 1), combination therapy (n = 3), case series (n = 2), and case report (n = 2). Ultimately, four paired observational cohort studies were included in this meta‐analysis. The PRISMA flow diagram for the meta‐analysis is shown in Figure 1 [11, 12, 13, 14].

FIGURE 1.

Study selection flow diagram. Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA).

A total of 397 patients were enrolled from all included studies. Following the initial evaluation and monitoring period, all 397 patients received the sacubitril/valsartan. Patients had a median age of 67.7–69.5 years and were predominantly male (77.3%). The studies were based in Portugal (n = 2), Spain (n = 1), and Belgium (n = 1). The detailed characteristics of the studies included in the meta‐analysis are shown in Table 1.

TABLE 1.

Characteristics of the studies included in the meta‐analysis.

Study, year	Location	Setting	Patients	Age; mean ± SD (years)	Male (%)	Sacubitril/valsartan	Control	Follow‐up (months)	Other treatments (%)
Martens et al., 2019 [12]	Belgium	Retrospective Cohort Study	All patients with symptomatic HFrEF with ICD or CRT	67.7 ± 9.9	123 (82)	After initiation (N = 151)	Before initiation (N = 151)	Intervention: 6 Control group: 6	ACE‐I/ARB (100), BB (95), MRA (86), Loop diuretic (48), Ivabradine (11), Digoxin (9), Amiodarone (33)
Medeiros et al., 2023 [13]	Portugal	Prospective cohort study	All patients with symptomatic HFrEF with ICD or CRT	69.5 ± 1.7	40 (74)	After initiation (N = 54)	Before initiation (N = 54)	Intervention: 12 Control group: 12	ACE‐I/ARB (100), BB (100), MRA (72.2), Amiodarone (22.2)
Diego et al., 2018 [11]	Spain	Retrospective cohort study	All patients with symptomatic HFrEF with ICD or CRT	69 ± 8	91 (76)	After initiation (N = 120)	Before initiation (N = 120)	Intervention: 9 Control group: 9	ACE‐I/ARB (100), BB (98), MRA (97), Antiarrhythmic drugs (30), Oral Diuretic (75)
Barradas et al., 2025 [14]	Portugal	Retrospective cohort study	All patients with HF with CRT	68.3 ± 12.2	53 (73.3)	After initiation (N = 72)	Before initiation (N = 72)	Mean = 20.8	ACE‐I/ARB (77.8), BB (93.1), MRA (68.1), Loop diuretic (83.3), Ivabradine (11.1), Digoxin (24.1), Amiodarone (33.3), SGLT2 inhibitors (22.2)

Abbreviations: ACE‐I, angiotensin‐converting‐enzyme inhibitors; ARB, angiotensin receptor blockers; BB, beta blocker; CRT, cardiac resynchronization therapy; HF, heart failure; HFrEF, heart failure with reduced ejection fraction; ICD, implantable cardioverter‐defibrillator; MRA, mineralocorticoid receptor antagonist.

3.2. Risk‐of‐Bias Assessment

The risk of bias for the included observational studies was assessed using the ROBINS‐I tool. Overall risk of bias for the included studies was moderate. The results were shown in Figure 2.

FIGURE 2.

The results of the risk of bias assessment using ROBINS‐I among included studies.

3.3. The Impact of Sacubitril/Valsartan on Ventricular Arrhythmia

Four observational studies assessed the effects of sacubitril/valsartan on ventricular arrhythmia in individuals with a cardiac defibrillator; data analysis didn't reveal a significant reduction in the rate of ventricular arrhythmia from baseline to the end of the trial with sacubitril/valsartan compared to the control group (OR, 0.55; 95% CI, 0.29 to 1.02; p = 0.06; I ² = 69%) [11, 12, 13, 14].

We also subgroup analyzed the studies based on the rate of SVT and NSVT among individuals with VT. The result of studies revealed that the incidence of SVT was not significantly different between the sacubitril/valsartan group and the control group (OR, 0.34; 95% CI, 0.07 to 1.71; p = 0.19; I ² = 50%) [11, 13]. Additionally the result didn't demonstrate a significant reduction in NSVT incidence (OR, 0.67; 95% CI, 0.43 to 1.06; p = 0.09; I ² = 55%) [11, 12, 13, 14]. The results are presented in Figure 3.

FIGURE 3.

(a) Impact of sacubitril/valsartan on ventricular arrhythmia among individuals with HF implanted with a cardiac defibrillator. (b) Impact of sacubitril/valsartan on the rate of SVT and NSVT among individuals with HF implanted with a cardiac defibrillator. CI, confidence interval; HF, heart failure; M‐H, Mantel–Haenszel; NSVT, non‐sustained ventricular tachycardia; SVT, sustained ventricular tachycardia.

3.4. The Impact of Sacubitril/Valsartan on ICD Shocks

The analysis of four observational studies indicated that there was a significant difference in the incidence of ICD shocks between the groups treated with sacubitril/valsartan and the control group (OR, 0.33; 95% CI, 0.19–0.60; p = 0.0003; I ² = 13%) [11, 12, 13, 14].

The result subgroup analyzed based on ICD shock type and results demonstrated that sacubitril/valsartan could significantly reduce the incidence of appropriate ICD shocks in individuals with a cardiac defibrillator (OR, 0.21; 95% CI, 0.10 to 0.47; p = 0.0001; I ² = 0%) [11, 12, 13]. Nonetheless, sacubitril/valsartan did not demonstrate a significant impact on the incidence of inappropriate ICD shocks (OR, 0.50; 95% CI, 0.12 to 2.08; p = 0.34; I ² = 0%) [11, 12]. The results have been summarized in Figure 4.

FIGURE 4.

(a) Impact of sacubitril/valsartan on the incidence of ICD shocks arrhythmia among individuals with HF implanted with cardiac defibrillator. (b) Impact of sacubitril/valsartan on the incidence of appropriate ICD shocks and inappropriate ICD shocks among individuals with HF implanted with cardiac defibrillator. CI, confidence interval; HF, heart failure; ICD, implantable cardioverter‐defibrillator; M‐H, Mantel–Haenszel.

3.5. Other Outcomes

The effects of the sacubitril/valsartan on LVEF were reported in two studies. Data analysis showed that the sacubitril/valsartan did not have a significant effect on the improvement of LVEF from baseline compared with the control group (MD, 2.98; 95% CI, −1.30 to 7.26; p = 0.17; I ² = 79%) [13, 14].

According to the findings reported by Diego et al. and Martens et al., the effects of sacubitril/valsartan on NSVT duration, Biv‐pacing < 90%, and PVCs per hour were evaluated. Pooled data analysis revealed a significant reduction in NSVT duration with sacubitril/valsartan treatment in comparison to the control group (MD, −1.86; 95% CI, −3.43 to −0.30; p = 0.02; I ² = 86%) [11, 12]. Additionally, data derived from two observational studies indicated a significantly lower risk of Biv‐pacing < 90% compared to the control group (OR, 0.15; 95% CI, 0.03 to 0.83; p = 0.03; I ² = 0%) [11, 12]. Conversely, treatment with sacubitril/valsartan demonstrated no notable reduction in PVC burden (MD, −28.21; 95% CI, −61.04 to 4.62; p = 0.09; I ² = 100%) [11, 12]. These results are shown in Figure 5.

FIGURE 5.

(a) Impact of sacubitril/valsartan on LVEF among individuals with HF implanted with a cardiac defibrillator. (b) Impact of sacubitril/valsartan on NSVT duration among individuals with HF implanted with a cardiac defibrillator. (c) Impact of sacubitril/valsartan on Biv‐pacing < 90% among individuals with HF implanted with a cardiac defibrillator. (d) Impact of sacubitril/valsartan on PVCs per hour among individuals with HF implanted with a cardiac defibrillator. Biv‐pacing, biventricular (Biv) pacing; CI, confidence interval; HF, heart failure; LVEF, left ventricular ejection fraction; M‐H, Mantel–Haenszel; NSVT, non‐sustained ventricular tachycardia; PVCs, premature ventricular contractions.

3.6. GRADE Evidence Profile

Sacubitril/valsartan demonstrated a moderate certainty of evidence for reducing overall ICD shocks and biventricular pacing < 90%, and a high certainty for reducing appropriate ICD shocks, with consistent results and low heterogeneity. Conversely, outcomes such as ventricular arrhythmias, SVT, NSVT incidence, and LVEF improvement were graded as low certainty due to heterogeneity, limited sample sizes, and wide confidence intervals. NSVT duration and PVC burden were rated as low to very low certainty, largely due to very high heterogeneity and imprecision. The results were shown in Table 2.

TABLE 2.

GRADE evidence profile for sacubitril/valsartan among heart failure individuals with implanted cardiac defibrillators.

Outcome	Risk of bias	Inconsistency (I 2)	Indirectness	Imprecision	Publication bias	Overall certainty
Ventricular arrhythmias	Moderate	High (69%)	None	Serious	Possible	Low
SVT incidence	Moderate	Moderate (50%)	None	Serious	Possible	Low
NSVT incidence	Moderate	Moderate (55%)	None	Serious	Possible	Low
ICD shocks	Moderate	Low (13%)	None	Moderate	Possible	Moderate
Appropriate ICD shocks	Moderate	None (0%)	None	Low	Possible	High
Inappropriate ICD shocks	Moderate	None (0%)	None	Serious	Possible	Low
NSVT duration	Moderate	Serious (86%)	None	Serious	Possible	Low
Biv pacing < 90%	Moderate	None (0%)	None	Low	Possible	Moderate
PVCs/h	Moderate	Very serious (100%)	None	Serious	Possible	Very low
LVEF improvement	Moderate	Serious (79%)	None	Serious	Possible	Low

Abbreviations: ICD, implantable cardioverter‐defibrillator; LVEF, left ventricular ejection fraction; NSVT, non‐sustained ventricular tachycardia; PVCs, premature ventricular contractions per hour; SVT, sustained ventricular tachycardia.

4. Discussion

To the best of our knowledge, this meta‐analysis is the first one that represents the impact of sacubitril/valsartan on ventricular arrhythmias in HF patients with cardiac defibrillators. The findings showed a potential benefit of sacubitril/valsartan in reducing appropriate ICD shocks, while demonstrating non‐significant impacts on overall arrhythmic burden and cardiac function.

4.1. Impact on Ventricular Arrhythmias and ICD Shock

A recent meta‐analysis demonstrated that sacubitril/valsartan didn't significantly reduce the overall risk of arrhythmia in HF patients, while a significant reduction in severe arrhythmias and VT was observed in HFrEF and suggests that the potential anti‐arrhythmic effect of sacubitril/valsartan is restricted to HFrEF patients [5]. However, in our pooled analysis of four observational cohort studies, there was no significant effect on the overall incidence of ventricular arrhythmias (OR, 0.55; 95% CI, 0.29 to 1.02), SVT, or NSVT. The discrepancy in findings could be explained by differences in study design, patient population, baseline characteristics, and follow‐up durations. In addition, our study demonstrated that sacubitril/valsartan significantly reduced the incidence of ICD shocks, particularly appropriate shocks (OR, 0.21; 95% CI, 0.10 to 0.47). The low heterogeneity observed for ICD shock results (I ² = 13%) indicates the consistency of this effect, while the moderate‐to‐high heterogeneity seen in overall arrhythmia outcomes (I ² = 55%–69%) likely reflects variation in patient characteristics and follow‐up duration. The results demonstrated that the primary antiarrhythmic effect of sacubitril/valsartan may result from a reduction in ICD interventions rather than a consistent prevention of arrhythmia incidence.

4.2. Impact on Cardiac Function and Surrogate Outcomes

In our analysis, sacubitril/valsartan did not significantly improve LVEF (MD, 2.98; 95% CI, −1.30 to 7.26), which contrasts with previous studies indicating varying improvements in LVEF after sacubitril/valsartan treatment [15, 16]. The discrepancy in findings may be attributed to the limited number of available studies involving 126 patients, and heterogeneity was substantial. Conversely, the intervention was associated with a notable decrease in the duration of NSVT (MD, −1.86; 95% CI, −3.40 to −0.30) and a lower risk of Biv‐pacing < 90% (OR, 0.15; 95% CI, 0.03 to 0.83). These findings suggest that sacubitril/valsartan may offer electrophysiologic benefits not fully reflected in overall LVEF improvement, potentially through modulation of arrhythmogenic substrate or reverse remodeling. No significant effect on PVC burden was observed (MD, −28.21; 95% CI, −61.04 to 4.62), likely due to the limited number of studies and variations in monitoring techniques.

Although a reduction in PVC burden could theoretically contribute to the lower incidence of biventricular pacing < 90%, our pooled analysis did not show a statistically significant decrease in PVCs. This observation may be due to the non‐significant change in PVC burden and the limited number of contributing studies. Further studies are needed to clarify this relationship.

4.3. Suggested Antiarrhythmic Mechanisms of Sacubitril/Valsartan

Sacubitril/valsartan exerts antiarrhythmic benefits through several mechanisms.

This medication potentially suppresses the renin–angiotensin–aldosterone system (RAAS) and blockade of angiotensin II type‐1 receptors, leading to promoting reverse remodeling, thereby decreasing myocardial fibrosis and hypertrophy and reducing arrhythmic substrate [17]. Also, neprilysin inhibition results in increased atrial and brain natriuretic peptide levels, activation of guanylate cyclase–cGMP–protein kinase G cascade, enhancing sarcoplasmic reticulum calcium reuptake, and inhibition of protein kinase C channels collectively promotes vasodilation and anti‐fibrotic effects [18, 19, 20, 21, 22, 23, 24]. Moreover, neprilysin inhibition results in elevated levels of bradykinin, which contribute to vasodilation, cardioprotective, and antifibrotic effects by activation of the beta‐2 receptor, stimulating nitric oxide and prostacyclin pathways [25, 26, 27, 28].

Preclinical studies demonstrate that ARNI shortens prolonged action potential duration (APD) and reduces early after depolarizations (EADs), and normalizes repolarization [29, 30]. This effect is likely attributed to electrical remodeling, such as the amelioration of calcium homeostasis [31, 32]. In addition, ARNI therapy improves autonomic function and decreases the likelihood of afterdepolarizations by reducing sympathetic hyperactivity, which contributes to the reduction of arrhythmic vulnerability [24, 33, 34]. However, these mechanisms warrant further investigations in humans.

4.4. Publication Bias

Because fewer than 10 studies were included in this meta‐analysis, formal statistical tests for publication bias (e.g., Egger's or Begg's test) and visual inspection of funnel plot asymmetry were not applicable to perform, in accordance with Cochrane recommendations. With only four studies, any apparent asymmetry would likely reflect sampling variation rather than true publication bias.

4.5. Limitation of Included Studies

Firstly, in our study, the follow‐up duration of included studies ranged from 6 to 57 months. Since ventricular arrhythmic events typically occur over a longer timeframe, it can be assumed that longer follow‐up duration studies are needed to draw a clear conclusion. Secondly, none of the included studies provided arrhythmic outcomes for primary and secondary prevention; therefore, subgroup analyses could not be performed, representing a limitation that may influence the observed effects of sacubitril/valsartan. Another limitation for included studies is that arrhythmia outcomes for ischemic and non‐ischemic cardiomyopathy are not reported, and subgroup analyses could not be applied, which may affect the study results.

4.6. Study Strengths and Limitations

This study provides valuable evidence for the beneficial effect of sacubitril/valsartan on arrhythmic outcomes among patients with ICDs or CRT devices. The consistent reduction in appropriate ICD shocks suggests a possible protective effect, which may contribute to improved prognosis and patient‐reported outcomes. However, the findings should be interpreted cautiously due to some important concerns. First, the results are based on observational studies, including four studies with a moderate risk of bias according to ROBINS‐I assessments. Second, the included studies varied in patient populations, follow‐up durations, baseline arrhythmic risk, device programming, and the number of studies. Third, this meta‐analysis had a modest sample size and studies undertaken in a few countries, which restricts generalizability. These factors should be considered when interpreting the results.

4.7. Future Direction

The GRADE assessment indicates that sacubitril/valsartan provides the most reliable benefit in reducing appropriate ICD shocks, while evidence for arrhythmia reduction and cardiac functional improvement remains uncertain. Further prospective and large clinical trials with long‐term follow‐up duration are required to confirm the antiarrhythmic effect of sacubitril/valsartan in this setting.

5. Conclusion

Based on the meta‐analysis of the observational studies, sacubitril/valsartan treatment in HF patients with ICD/CRT demonstrated a significant reduction in the risk of appropriate ICD shocks; however, its effects on overall ventricular arrhythmias and LVEF remain to be elucidated. Therefore, further well‐designed studies are needed to confirm these findings.

Funding

The authors have nothing to report.

Ethics Statement

The authors have nothing to report.

Conflicts of Interest

The authors declare no conflicts of interest.

Asham H., Salehian S., Gharekhani A., Safaei N., Sarbakhsh P., and Entezari‐Maleki T., “Efficacy of Sacubitril/Valsartan Among Heart Failure Individuals With Implanted Cardiac Defibrillators: A Systematic Review and Meta‐Analysis,” Journal of Arrhythmia 41, no. 6 (2025): e70247, 10.1002/joa3.70247.