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

Department of Cardiology, San Filippo Neri Hospital, University of Tor Vergata, Rome, Italy.
Europace (Impact Factor: 3.67). 11/2010; 13(2):174-81. DOI: 10.1093/europace/euq386
Source: PubMed


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.

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Available from: Leopoldo Bianconi
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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 "
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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. "
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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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    • "Recently, a number of RCT has been reported (Table 2), of which two showed a beneficial effect of treatment with marine n−3 PUFA (Nodari et al., 2011; Kumar et al., 2012), whereas this was not found in three other studies (Kowey et al., 2010; Bianconi et al., 2011; Ozaydin et al., 2011). "
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    ABSTRACT: Marine n-3 polyunsaturated fatty acids (PUFA) may have beneficial effects in relation to atrial fibrillation (AF) with promising data from experimental animal studies, however, results from studies in humans have been inconsistent. This review evaluates the mechanisms of action of marine n-3 PUFA in relation to AF based on experimental data and provides a status on the evidence obtained from observational studies and interventional trials. In conclusion, there is growing evidence for an effect of marine n-3 PUFA in prevention and treatment of AF. However, further studies are needed to establish which patients are more likely to benefit from n-3 PUFA, the timing of treatment, and dosages.
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