From the Research
The decision to hold Entresto (sacubitril/valsartan) in a patient who experienced ventricular tachycardia (VTac) should be made on a case-by-case basis, but generally, temporary discontinuation may be warranted until the patient is stabilized, as supported by the most recent study 1. When considering the management of a patient with VTac who is on Entresto, several factors must be taken into account, including the potential for Entresto to lower blood pressure and exacerbate hemodynamic instability, as well as its benefits in reducing cardiac remodeling and mortality in heart failure patients 2. Key considerations include:
- The presence of hypotension or hemodynamic compromise, in which case Entresto should be held to avoid worsening the patient's condition 3.
- The need to correct electrolyte abnormalities and monitor the patient closely for blood pressure, renal function, and potassium levels when restarting Entresto therapy 4.
- The potential for sacubitril/valsartan to reduce the burden of premature ventricular complexes and increase the percentage of biventricular pacing, as observed in a recent observational study 1.
- The importance of identifying and addressing the underlying cause of the VTac episode before reintroducing Entresto, potentially at a lower dose with gradual uptitration as tolerated 5. Ultimately, the goal is to balance the benefits of Entresto in managing heart failure with the need to ensure the patient's safety and stability in the face of a VTac episode, prioritizing morbidity, mortality, and quality of life as the outcome.