Article

n-3 Polyunsaturated Fatty Acids in the Prevention of Atrial Fibrillation Recurrences After Electrical Cardioversion A Prospective, Randomized Study

Department of Experimental and Applied Medicine, Section of Cardiovascular Diseases, University of Brescia Medical School, P. le Spedali Civili, 1-25123 Brescia, Italy.
Circulation (Impact Factor: 14.95). 08/2011; 124(10):1100-6. DOI: 10.1161/CIRCULATIONAHA.111.022194
Source: PubMed

ABSTRACT n-3 polyunsaturated fatty acids (n-3 PUFAs) exert antiarrhythmic effects and reduce sudden cardiac death. However, their role in the prevention of atrial fibrillation remains controversial. We aimed to determine the effect of n-3 PUFAs in addition to amiodarone and a renin-angiotensin-aldosterone system inhibitor on the maintenance of sinus rhythm after direct current cardioversion in patients with persistent atrial fibrillation.
We conducted a randomized, double-blind, placebo-controlled, parallel-arm trial in patients with persistent atrial fibrillation, with at least 1 relapse after cardioversion, and treated with amiodarone and a renin-angiotensin-aldosterone system inhibitor. Participants were assigned to placebo or n-3 PUFAs 2 g/d and then underwent direct current cardioversion 4 weeks later. The primary end point was the probability of maintenance of sinus rhythm at 1 year after cardioversion. Of 254 screened patients, 199 were found to be eligible and randomized. At the 1-year follow up, the probability of maintenance of sinus rhythm was significantly higher in the n-3 PUFAs-treated patients compared with the placebo group (hazard ratio, 0.62 [95% confidence interval, 0.52 to 0.72] and 0.36 [95% confidence interval, 0.26 to 0.46], respectively; P=0.0001).
In patients with persistent atrial fibrillation on amiodarone and a renin-angiotensin-aldosterone system inhibitor, the addition of n-3 PUFAs 2 g/d improves the probability of the maintenance of sinus rhythm after direct current cardioversion. Our data suggest that n-3 PUFAs may exert beneficial effects in the prevention of atrial fibrillation recurrence. Further studies are needed to confirm and expand our findings. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT01198275.

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    • "Although those observational results were encouraging, subsequent randomized trials brought up controversial results. The study by Nodari et al. (2011), in patients with persistent AF and at least one relapse after cardioversion , showed significant decrease in AF recurrences after "
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    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.
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    • "Omega-3 polyunsaturated fatty acid supplementation has not been definitively shown to have a positive impact on incidence or recurrence of AF. In fact, the weight of evidence is mostly against any benefit [192] [193] [194] [195]. "
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    • "We critically reviewed recent large clinical trials reporting data on the antiarrhythmic effects of n−3 PUFA in different clinical settings, i.e., patients with CHD (Marchioli et al., 2002; Yokoyama et al., 2007; Rauch et al., 2010), heart failure (HF; Tavazzi et al., 2008), with implantable cardioverter defibrillator (ICD; Leaf et al., 2005; Raitt et al., 2005; Brouwer et al., 2006), and at risk of atrial fibrillation (AF; Calo et al., 2005; Kowey et al., 2010; Nodari et al., 2011), in order to summarize the results which are available up to date and possibly give " substantiated " fuel to the debate on the conflicting results of n−3 PUFA. "
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