N-3 Polyunsaturated fatty acids for the prevention of arrhythmia recurrence after electrical cardioversion of chronic persistent atrial fibrillation: A randomized, double-blind, multicentre study
ABSTRACT Persistent atrial fibrillation (AF) often recurs after direct current electrical cardioversion (ECV). As several experimental and clinical studies suggest that n-3 polyunsaturated fatty acids (PUFAs) may have antiarrhythmic properties even at the atrial level, we aimed to evaluate whether oral supplementation with PUFAs, in addition to conventional antiarrhythmic drugs, could reduce the recurrence rate of the arrhythmia after ECV of persistent AF.
Two hundred and four patients (mean age 69.3 years, 33% females) with persistent AF were randomly assigned to receive 3 g/day of PUFAs until ECV and 2 g/day thereafter (104 patients) or placebo (100 patients) for 6 months, beginning at least 1 week before ECV. Selection of conventional antiarrhythmic prophylaxis was left to local medical advice. The cardiac rhythm was assessed by both trans-telephonic monitoring and clinical visits. Primary end-point was the recurrence rate of AF. Sinus rhythm was restored, either spontaneously or after ECV, in 187 patients (91.7%); 95 patients (91.4%) on PUFAs and 92 patients (92.0%) on placebo (P=not significant). AF relapsed in 56 (58.9%) of the PUFAs patients and in 47 (51.1%) of the placebo patients (P=0.28). The mean time to AF recurrence was 83±8 days in the PUFAs group and 106±9 days in the placebo group (P=0.29).
Our results do not support the hypothesis that, in patients undergoing ECV of chronic persistent AF, supplementation with PUFAs in addition to the usual antiarrhythmic treatment reduces recurrent AF.
Full-textDOI: · Available from: Leopoldo Bianconi, Aug 26, 2015
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Article: N-3 Polyunsaturated fatty acids for the prevention of arrhythmia recurrence after electrical cardioversion of chronic persistent atrial fibrillation: A randomized, double-blind, multicentre study
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- " results ( Mozaffarian et al . 2004 , primary prevention by fish intake in patients > 65 years of age ; Calò L et al . 2005 , patients undergoing coronary artery surgery ; Macchia A et al . 2008 , post myocardial infarction patients ) were not confirmed in more recent studies and meta - analyses ( Kowey PR et al . 2010 ; Saravanan P et al . 2010 ; Bianconi L et al . 2011 ; Farquharson AL et al . 2011 ; Liu T at al . 2011 ) . In the multinational OPERA trial including 1 , 516 patients undergoing cardiac surgery perioperative Ω - 3 supplementation also did not reduce the risk of postoperative atrial fibrillation ( Mozaffarian D et al . 2012 ) . On the other hand supplementation with DHA 1 . 5 g and EPA 0 "
ABSTRACT: The effects of supplementation of the omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) on prevalence and severity of depression were evaluated in patients after a myocardial infarction. A cross-sectional evaluation (posttest-only design) within the prospective, randomized, controlled, multicenter OMEGA trial was performed in patients after myocardial infarction at 12 months' follow-up (N = 2,081; age, mean = 64 years; men, 76.7%; women, 21.8%) from April 2005 to June 2007. Patients received supplementation with ethyl esters 90 (460-mg EPA and 380-mg DHA) or placebo for 12 months. Depression was assessed with the Beck Depression Inventory-II (BDI-II); a BDI-II cutoff score of ≥ 14 was used as diagnosis of depression. When the total population was evaluated, no effects of EPA/DHA supplementation on depressive symptoms according to BDI-II score (mean [SD]) could be demonstrated: EPA/DHA (n = 1,046), 7.1 (6.9); placebo (n = 1,035), 7.1 (7.0); P = .7. The post hoc analyses of depressed patients with and without antidepressants revealed a tendency toward an antidepressant effect in patients with EPA/DHA supplementation as monotherapy: EPA/DHA (n = 125), 19.4 (5.8); placebo (n = 113), 19.9 (5.1); P = .07. However, in depressed patients with EPA/DHA supplementation as adjunctive to conventional antidepressants, a clinically relevant antidepressant effect was demonstrated: EPA/DHA (n = 33), 20.9 (7.1); placebo (n = 29), 24.9 (8.5); P < .05. EPA/DHA supplementation in the total sample of patients after myocardial infarction had no effect on depressive symptoms. The clinically relevant antidepressant effect in the subgroup of depressed patients with EPA/DHA supplementation as adjunctive to conventional antidepressants that was revealed in the post hoc analysis might provide a basis for a controlled, prospective trial of omega-3 augmentation of antidepressants in patients after myocardial infarction. ClinicalTrials.gov identifier: NCT00251134.The Journal of Clinical Psychiatry 11/2013; 74(11):e1037-e1045. DOI:10.4088/JCP.13m08453 · 5.14 Impact Factor
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- "More recently, in a similar AF population, the study by Kumar et al. (2012) showed that fish oil supplementation resulted in a sixfold prolongation in the median time to AF recurrence compared to controls. Conversely, two other randomized trials by Kowey et al. (2010); Bianconi et al. (2011) did not show any beneficial effect of n-3 PUFAs in preventing AF recurrences in persistent AF patients after cardioversion or in sinus rhythm patients with previously documented AF, respectively. Again, several methodological factors may partly explain these discordant findings. "
ABSTRACT: Atrial fibrillation (AF) is the most common sustained arrhythmia encountered in clinical practice with growing prevalence in developed countries. Several medical and interventional therapies, such as atrial specific drugs and pulmonary vein isolation, have demonstrated prevention of recurrences. However, their suboptimal long-term success and significant rate of secondary effects have led to intensive research in the last decade focused on novel alternative and supplemental therapies. One such candidate is polyunsaturated fatty acids (PUFAs). Because of their biological properties, safety, simplicity, and relatively cheap cost, there is a special clinical interest in omega-3 PUFAs as a possible antiarrhythmic agent. Obtained from diets rich in fish, they represent one of the current supplemental therapies. At the cellular level, an increasing body of evidence has shown that n-3 PUFAs exert a variety of effects on cardiac ion channels, membrane dynamic properties, inflammatory cascade, and other targets related to AF prevention. In this article, we review the current basic and clinical evidence pertinent to n-3 PUFAs in AF treatment and prevention. We also discuss controversial outcomes among clinical studies and propose specific subsets of AF patients who will benefit most from n-3 PUFAs.Frontiers in Physiology 09/2012; 3:370. DOI:10.3389/fphys.2012.00370 · 3.50 Impact Factor
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ABSTRACT: The marine-derived long chain omega-3 (n-3) polyunsaturated fatty acids (PUFA) eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) have a broad spectrum of cardioprotective effects. Over the past three decades, accumulated evidence from both observational and interventional studies have demonstrated that increased intake of fish or fish-derived n-3 PUFAs decreases risk of major cardiovascular disease ( CVD) events. The benefits of eating fish appear to outweigh the potential risk of mercury exposure from consuming fish. Their use, therefore, has been included in the guidelines to prevent CVD in both the general population and in patients with a history of CVD. However, several questions remain regarding their effectiveness in primary prevention, the potential pro-arrhythmic effect, and the optimal dosage needed to achieve the reduction of CVD risk and targeted subpopulation. This article summarizes the most recent scientific data for n-3 PUFAs in the prevention of CVD and risk factors with the aim to address those uncertain areas.Current Cardiovascular Risk Reports 02/2011; 6(1). DOI:10.1007/s12170-011-0205-1