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: 14.43). 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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Available from: Cesana Bruno Mario, Nov 19, 2015
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    • "Perioperative intravenous infusion of polyunsaturated fatty acids (PUFA) reduced the incidence of AF after CABG leading to a shorter stay in the intensive care unit (ICU) and in hospital [22]. However, outcome of clinical research has been contradictory, and a definite role of omega-3 FA in the setting of AF has not been demonstrated [23]. The results of the OMEGA, a randomized, placebo-controlled trial to test the effect of highly purified omega-3 FA on top of modern guideline-adjusted therapy after myocardial infarction, showed a low rate of SCD, total mortality, and major adverse cerebrovascular and cardiovascular events within 1 year of followup after guideline- adjusted treatment and secondary prevention of acute myocardial infarction [24]. "
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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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