Sacubitril/valsartan for heart failure in adults with complex congenital heart disease.

BACKGROUND: Heart failure is an important cause of morbidity and mortality in adults with congenital heart disease (ACHD). Sacubitril/valsartan is an established treatment for heart failure with reduced ejection fraction due to acquired cardiovascular disease. Data in adults with complex congenital heart disease (CHD) is lacking. METHODS: Retrospective study of ACHD patients with CHD of moderate/severe complexity and heart failure under treatment with sacubitril/valsartan. Clinical data was retrieved from medical records. RESULTS: Altogether, 23 patients (mean age 41.2 ±â€¯11.9 years, female 17.4%) were included. A systemic right ventricle was present in 12 pat. (52.2%), a single ventricle physiology in 4 (17.4%), and a systemic left ventricle in 7 (30.4%). During a median follow-up of 221 days [IQR 79-430], systemic ventricular function (p = 0.88) and functional status according to New York Heart Association class (p = 0.38) did not improve. While NT-proBNP levels did not change significantly under treatment (2561 ±â€¯2042 ng/l vs. 1938 ±â€¯1524 ng/l, p = 0.20), creatinine levels increased (1.14 ±â€¯0.52 mg/dl vs. 1.35 ±â€¯0.74 mg/dl, p = 0.002). Systolic (110 ±â€¯15 mm Hg vs. 103 ±â€¯14 mm Hg, p = 0.02) and diastolic blood pressures (68 ±â€¯10 mm Hg vs. 61 ±â€¯12 mm Hg, p = 0.01) were reduced under therapy. Five patients discontinued therapy, four of these due to side effects. CONCLUSION: In this small group of complex ACHD patients with heart failure, treatment with sacubitril/valsartan did not improve systemic ventricular function or functional status. Renal function needs close surveillance.

Two-Year Follow-up in Atrial Fibrillation Patients Referred for Catheter Ablation of the Atrioventricular Node.

INTRODUCTION: At the present time there is still concern regarding the long-term deleterious effects of right ventricular apical pacing in patients referred for auriculoventricular node ablation (AVNA). Furthermore, scarce information is available regarding differences in the follow up according to the baseline cardiopathy and predictors associated with a worse outcome. METHODS: 104 consecutives patients referred for AVNA were retrospectively analyzed. Patients included were seen in the outpatient clinic at 6, 12 and 24 months post ablation (mean follow-up 24 ± 2 months). An echocardiogram two years after the procedure was obtained in 68 patients. Three categories were done according to the change in the left ventricular function (LVEF) (increase, decrease or absence of change, defined as less than 10% variation in either LVEF). RESULTS: After two years of follow up there was a decrease in the rate of hospital admission (from 0.9 admission/year to 0.35, p<0.001), an increase in the functional status in at least one NYHA class in 58 patients, and an increase in the global LVEF (from 48.9% to 54,1%; p<0.001). Valvular replacement and LVEF less than 50% were independently associated with a decrease in the LVEF. Regarding safety issues, one patient who presented a polymorphic ventricular tachycardia (Torsade de pointes) 60 minutes after the ablation. CONCLUSIONS: AVNA results in a decrease in hospital admission rates and an improvement in functional status. Baseline LVEF < 50% and mitral valvulopathy were multivariate predictor of LVEF decline, hence, it is our belief that, in this particular population, the "ablate and pace" strategy is not the most suitable option, and or maybe a biventricular pacemaker should be implanted or an AF ablation reconsidered." Finally, although it is a safe procedure and rate of complications were low, there is a potential risk of fatal complications.