Sacubitril/Valsartan and implantable cardioverter-defibrillators: evolving therapeutic strategies. A case report

Heart failure is a major public health concern, being one of the most common reasons for hospitalization. Its prognosis is poor and the optimal management to date represents a continuous challenge. This case report describes a 67-year-old man with chronic heart failure with reduced ejection fraction (HFrEF), remaining symptomatic despite optimal medical therapy and refusing an implantable cardioverter-defibrillator (ICD) as a prevention for sudden cardiac death. We introduced Sacubitril/Valsartan and after 3 months of treatment we observed a significant improvement in symptoms with reduction of arrhythmic burden and, after six months even of echocardiographic parameters, leading to withdraw the indication to the ICD.