Angiotensin Receptor-Neprilysin Inhibitor (ARNI) and Cardiac Arrhythmias

Henry Sutanto, Dobromir Dobrev, Jordi Heijman*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

9 Citations (Web of Science)

Abstract

The renin-angiotensin-aldosterone system (RAAS) plays a major role in cardiovascular health and disease. Short-term RAAS activation controls water and salt retention and causes vasoconstriction, which are beneficial for maintaining cardiac output in low blood pressure and early stage heart failure. However, prolonged RAAS activation is detrimental, leading to structural remodeling and cardiac dysfunction. Natriuretic peptides (NPs) are activated to counterbalance the effect of RAAS and sympathetic nervous system by facilitating water and salt excretion and causing vasodilation. Neprilysin is a major NP-degrading enzyme that degrades multiple vaso-modulatory substances. Although the inhibition of neprilysin alone is not sufficient to counterbalance RAAS activation in cardiovascular diseases (e.g., hypertension and heart failure), a combination of angiotensin receptor blocker and neprilysin inhibitor (ARNI) was highly effective in several clinical trials and may modulate the risk of atrial and ventricular arrhythmias. This review summarizes the possible link between ARNI and cardiac arrhythmias and discusses potential underlying mechanisms, providing novel insights about the therapeutic role and safety profile of ARNI in the cardiovascular system.

Original languageEnglish
Article number8994
Number of pages14
JournalInternational journal of molecular sciences
Volume22
Issue number16
DOIs
Publication statusPublished - 20 Aug 2021

Keywords

  • neprilysin
  • renin-angiotensin-aldosterone
  • arrhythmia
  • cardiovascular
  • pharmacology
  • heart rhythm
  • electrophysiology
  • heart failure
  • natriuretic peptide
  • HEART-FAILURE
  • ATRIAL-FIBRILLATION
  • NATRIURETIC PEPTIDE
  • EJECTION FRACTION
  • BLOOD-PRESSURE
  • SACUBITRIL/VALSARTAN
  • LCZ696
  • HYPERTENSION
  • METAANALYSIS
  • ENALAPRIL

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