Sacubitril–valsartan reduced clinically significant arrhythmias compared with ACEI or ARB therapy. The analysis, published in Circulation, evaluated arrhythmic outcomes between ARNI and ACEI/ARB treatments.

The review included 23 randomized and observational studies with 20,799 participants. Of these, 10,515 received ARNI and 9,261 received ACEI or ARB therapy. Records were eligible if they compared drug classes and reported VT/VF or AF/AFL. Pooled data were synthesized using random-effects models with heterogeneity assessed by the Q statistic.

VT/VF outcomes from seven randomized trials demonstrated a significant reduction with ARNI (OR 0.79, 95% CI 0.64–0.98). When all 12 VT/VF-reporting studies were analyzed, the direction of effect persisted but did not meet statistical significance. AF/AFL outcomes across 15 studies showed a 31% reduction with ARNI (OR 0.69, 95% CI 0.53–0.91), while randomized data alone showed a nonsignificant trend toward benefit.

These findings reinforce ARNI as a favorable therapy for reducing arrhythmic risk while emphasizing the need for rhythm-focused randomized trials to further define its protective value.