n-3 Polyunsaturated fatty acids for the prevention of postoperative atrial fibrillation

Benedetto, Umberto; Angeloni, Emiliano; Melina, Giovanni; Danesi, Tommaso Hinna; Bartolomeo, Roberta Di; Lechiancole, Andrea; Refice, Simone; Roscitano, Antonino; Comito, Cosimo; Sinatra, Riccardo

doi:10.2459/jcm.0b013e32834a13c1

Cited by 34 publications

(14 citation statements)

References 11 publications

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“…In turn, the unsuccessful studies showed a higher EPA/DHA ratio. This view is supported by a recent study reporting a trend toward a benefit from n −3 PUFA supplementation when the EPA/DHA ratio is 1/2 (Benedetto et al, 2011). However, more mechanistic studies to ascertain the molecular basis of these effects are still lacking.…”

Section: Prevention Of Postoperative Atrial Fibrillationmentioning

confidence: 70%

Prevention of Postoperative Atrial Fibrillation: Novel and Safe Strategy Based on the Modulation of the Antioxidant System

Rodrigo¹

2012

Front. Physio.

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Postoperative atrial fibrillation (AF) is the most common arrhythmia following cardiac surgery with extracorporeal circulation. The pathogenesis of postoperative AF is multifactorial. Oxidative stress, caused by the unavoidable ischemia–reperfusion event occurring in this setting, is a major contributory factor. Reactive oxygen species (ROS)-derived effects could result in lipid peroxidation, protein carbonylation, or DNA oxidation of cardiac tissue, thus leading to functional and structural myocardial remodeling. The vulnerability of myocardial tissue to the oxidative challenge is also dependent on the activity of the antioxidant system. High ROS levels, overwhelming this system, should result in deleterious cellular effects, such as the induction of necrosis, apoptosis, or autophagy. Nevertheless, tissue exposure to low to moderate ROS levels could trigger a survival response with a trend to reinforce the antioxidant defense system. Administration of n−3 polyunsaturated fatty acids (PUFA), known to involve a moderate ROS production, is consistent with a diminished vulnerability to the development of postoperative AF. Accordingly, supplementation of n−3 PUFA successfully reduced the incidence of postoperative AF after coronary bypass grafting. This response is due to an up-regulation of antioxidant enzymes, as shown in experimental models. In turn, non-enzymatic antioxidant reinforcement through vitamin C administration prior to cardiac surgery has also reduced the postoperative AF incidence. Therefore, it should be expected that a mixed therapy result in an improvement of the cardioprotective effect by modulating both components of the antioxidant system. We present novel available evidence supporting the hypothesis of an effective prevention of postoperative AF including a two-step therapeutic strategy: n−3 PUFA followed by vitamin C supplementation to patients scheduled for cardiac surgery with extracorporeal circulation. The present study should encourage the design of clinical trials aimed to test the efficacy of this strategy to offer new therapeutic opportunities to patients challenged by ischemia–reperfusion events not solely in heart, but also in other organs such as kidney or liver in transplantation surgeries.

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Section: Prevention Of Postoperative Atrial Fibrillationmentioning

confidence: 70%

Prevention of Postoperative Atrial Fibrillation: Novel and Safe Strategy Based on the Modulation of the Antioxidant System

Rodrigo¹

2012

Front. Physio.

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“…[102][103][104] Multiple randomized clinical trials have been performed since to assess the efficacy of fish oil in reducing AF after heart surgery. [105][106][107][108][109][110][111] Because of inconclusive results, a series of recent meta-analyses have been performed to test for a definite therapeutic effect of this intervention. 107-111 The 5 metaanalyses to date have yielded different conclusions, although the latest pair have both suggested that PUFA in fish oils significantly decreases the risk of AF after cardiac surgery.…”

Section: Fish Oilmentioning

confidence: 99%

“…107-111 The 5 metaanalyses to date have yielded different conclusions, although the latest pair have both suggested that PUFA in fish oils significantly decreases the risk of AF after cardiac surgery. [107][108][109][110][111] Given the recent positive meta-analysis, larges adequately powered multicenter randomized trials are indicated to evaluate the safety and efficacy of fish oil for prevention of AF after cardiac surgery.…”

Section: Fish Oilmentioning

confidence: 99%

Atrial Fibrillation After Cardiac Surgery: Clinical Update on Mechanisms and Prophylactic Strategies

Raiten

Ghadimi

Augoustides

et al. 2015

Journal of Cardiothoracic and Vascular Anesthesia

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“…He et al . concluded that n ‐3 PUFA supplementation could significantly reduce the incidence of AF after heart surgery, but had no significant effect on its recurrence, while others did not observe any favourable effect ,. The lack of effect of n ‐3 PUFA supplementation on post‐operative AF has been recently confirmed by the OPERA trial in 1516 patients .…”

Section: Discussionmentioning

confidence: 99%

n‐3 polyunsaturated fatty acids and atrial fibrillation in patients with chronic heart failure: the GISSI‐HF trial

Aleksova

Masson

Maggioni

et al. 2013

European J of Heart Fail

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AimsIn the last few years, n-3 polyunsaturated acids (PUFAs) have been extensively studied for the prevention of AF, mostly in patients without heart failure (HF) or LV dysfunction. This post-hoc analysis of the GISSI-HF trial assessed the effect of n-3 PUFAs on AF in patients with chronic HF without AF at study entry over a median follow-up of 3.9 years. Methods and resultsIn the GISSI-HF trial, 6975 patients with chronic HF were randomized to 1 g daily of n-3 PUFAs or placebo on top of recommended therapy for HF. Of these, 1140 (16.3%) had AF at baseline ECG and were excluded from the present analysis. AF during the trial was defined as the presence of AF on the ECGs done at each visit during the trial or AF as a cause of worsening HF or hospital admission or as an event during hospitalization. Dietary fish consumption and the circulating levels of n-3 PUFAs (the latter in a subset of 1203 patients) were also available. Among the 5835 patients without AF at study entry, 444 randomized to n-3 PUFAs (15.2%) and 408 to placebo (14.0%) developed AF (unadjusted hazard 1.10, P ¼ 0.19). Lower circulating n-3 PUFA levels were independently associated with higher AF prevalence at study entry, but not with its new occurrence. ConclusionsDespite an inverse relationship between plasma n-3 PUFA levels and prevalent AF, this study found no evidence that 1 g daily n-3 PUFA supplementation in patients with chronic HF reduces incident AF.--

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n-3 Polyunsaturated fatty acids for the prevention of postoperative atrial fibrillation

Abstract: In conclusion, the results of the present meta-analysis of randomized controlled trials suggest that preoperative n-3 PUFA therapy may not reduce POAF in patients undergoing cardiac surgery. However, several aspects may have influenced this negative result, which need to be investigated.

Cited by 34 publications

References 11 publications

Prevention of Postoperative Atrial Fibrillation: Novel and Safe Strategy Based on the Modulation of the Antioxidant System

Prevention of Postoperative Atrial Fibrillation: Novel and Safe Strategy Based on the Modulation of the Antioxidant System

Atrial Fibrillation After Cardiac Surgery: Clinical Update on Mechanisms and Prophylactic Strategies

n‐3 polyunsaturated fatty acids and atrial fibrillation in patients with chronic heart failure: the GISSI‐HF trial

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