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.
- Vojnosanitetski pregled. Military-medical and pharmaceutical review 01/2013; 70(5):484-492. · 0.27 Impact Factor
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ABSTRACT: Previous studies have suggested a lower risk of atrial fibrillation (AF) with higher intakes of fish and marine n-3 polyunsaturated fatty acids (PUFAs), but the results have been inconsistent. The aim was to investigate the association between consumption of marine n-3 PUFA and development of AF.METHODS AND RESULTS: A total of 57 053 Danish participants 50-64 years of age were enrolled in the Diet, Cancer, and Health Cohort Study between 1993 and 1997. Dietary intake of fish and marine n-3 PUFA was assessed by a semi-quantitative food frequency questionnaire. In total, 3345 incident cases of AF occurred over 13.6 years. Multivariate Cox regression analyses (3284 cases and 55 246 participants) using cubic splines showed a U-shaped association between consumption of marine n-3 PUFA and risk of incident AF, with the lowest risk of AF at a moderate intake of 0.63 g/day. For quintiles of marine n-3 PUFA intake, a 13% statistically significant lower risk of AF was seen in the middle vs. lowest quintile: Q1 reference, Q2 HR 0.92 (95% CI 0.82-1.03), Q3 HR 0.87 (95% CI 0.78-0.98), Q4 HR 0.96 (95% CI 0.86-1.08), and Q5 HR 1.05 (95% CI 0.93-1.18). Intake of total fish, fatty fish, and the individual n-3 PUFA eicosapentaenoic acid, docosahexaenoic acid, and docosapentaenoic acid also showed U-shaped associations with incident AF.CONCLUSION: We found a U-shaped association between consumption of marine n-3 PUFA and risk of incident AF, with the lowest risk close to the median intake of total marine n-3 PUFA (0.63 g/day).Europace 02/2014; · 3.05 Impact Factor
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ABSTRACT: Complementary and alternative medical (CAM) therapies are commonly used by patients for the treatment of medical conditions spanning the full spectrum of severity and chronicity. The use of alternative remedies, both herbal and others, for conditions lacking effective medical treatment, is on the increase. Included within this categorization, arrhythmic disease-absent effective catheter-based therapy or with medical therapy limited by the toxicities of contemporary antiarrhythmic agents is frequently managed by patients with CAM therapies without their practitioner's knowledge and in the face of potential herb-drug toxicities. This study reviews 9 CAM therapies: 7 individual herbal therapies along with acupuncture and yoga that have been studied and reported as having an antiarrhythmic effect. The primary focuses are the proposed antiarrhythmic mechanism of each CAM agent along with interactions between the CAM therapies and commonly prescribed medical therapy for arrhythmia patients. We stress persistent vigilance on the part of the provider in discussing the use of herbal or other CAM agents within the arrhythmia population.The American journal of cardiology 03/2014; 113(5):897-903. · 3.58 Impact Factor
JACC March 9, 2010
Volume 55, issue 10A
N-3 POLY-UNSATURATED FATTY ACIDS FOR THE PREVENTION OF ATRIAL FIBRILLATION RECURRENCE
AFTER ELECTRICAL CARDIOVERSION OF CHRONIC PERSISTENT ATRIAL FIBRILLATION. A RANDOMIZED,
DOUBLE-BLIND, MULTICENTRE STUDY.
ACC Poster Contributions
Georgia World Congress Center, Hall B5
Sunday, March 14, 2010, 3:30 p.m.-4:30 p.m.
Session Title: Clinical Electrophysiology--Supraventricular Arrhythmias
Abstract Category: Clinical Electrophysiology--Supraventricular Arrhythmias
Presentation Number: 1081-152
Authors: Leopoldo Bianconi, Leonardo Calò, Silvia Mennuni, Luca Santini, Paolo Morosetti, Paolo Azzolini, Giuseppe Barbato, Francesco Biscione,
Paolo Romano, Massimo Santini, Rome, Italy
Background: Persistent atrial fibrillation (AF) can be successfully terminated by Direct Current electrical cardioversion (ECV). However the
arrhythmia recurs in the majority of the cases despite treatment with antiarrhythmic drugs. Several experimental and clinical studies showed that
n-3 poly-unsaturated fatty acids (PUFAs) could have antiarrhythmic properties even at atrial level. The aim of this multicentre study was to assess if
oral PUFAs supplementation in patients undergoing ECV for persistent AF could reduce the recurrence rate of the arrhythmia.
Methods: A total of 204 patients (mean age 69.3 years, 33% females) with persistent AF were double blindly randomized to receive 2 grams a day
of PUFAs (104 patients) or placebo (100 patients), beginning at least one week before ECV until the end of the study. The use of other antiarrhythmic
drugs was left to the local medical decision. All the patients were followed up for 6 months and their rhythm was assessed both by trans-telephonic
monitoring and clinical visits. Primary end point was the recurrence rate of AF.
Results: After ECV (in case of a first unsuccessful ECV a second one could be attempted after modification of antiarrhythmic treatment) 187
patients (91.7%) were in sinus rhythm: 95 (91.4%) patients on PUFAs and 92 (92.0%) patients on placebo (p=NS). Atrial fibrillation 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). The absence of difference between the two groups of patients in the arrhythmia recurrence
was present both in patients off and on antiarrhythmic drugs, independently of the type of drug.
Conclusions: PUFAs supplementation at a dose of 2 grams a day, on top of standard antiarrhythmic treatment, in patients undergoing ECV of
chronic persistent AF was not able to reduce the recurrence of the arrhythmia.