Usefulness of Sacubitril/Valsartan in reduction of atrial fibrillation burden in a patient with ICD delivering inappropriate therapies. A new possibility?

Heart failure (HF) is currently a condition with high impact both in terms of clinical practice and of health care costs. Therapy with cardiac devices such as implantable cardioverter-defibrillators (ICD) is constantly evolving and often it is life-saving. However, in some cases it has minimal clinical impact on the symptoms. An optimal therapy is often not sufficient to avoid progression of the pathology, leading to arrhythmias such as atrial fibrillation, which could cause inappropriate delivery of therapies from the ICD. We describe the case of a patient with ICD who underwent cardiac evaluation in the Emergency Department because he experienced multiple episodes of dyspnea and palpitations. In this case a conservative approach by administration of Sacubitril/Valsartan avoided other more invasive approaches that otherwise in clinical practice should be attempted to avoid inappropriate shocks.