N-3 polyunsaturated fatty acids for prevention of postoperative atrial fibrillation: updated meta-analysis and systematic review

Wang, Hao; Chen, Jindong; Zhao, Liang

doi:10.1007/s10840-018-0315-5

Cited by 28 publications

(21 citation statements)

References 42 publications

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“…Early trials have not shown a reduction in AFACS [113], and a 2014 meta-analysis of 8 RCTs ( n = 2687) concluded that preoperative PUFA treatment did not influence AFACS incidence [86]. In 2017, a meta-analysis of 19 RCTs ( n = 4335) found a reduction in AFACS [87], and so did a 2018 meta-analysis that included 14 RCTs ( n = 3570), which found significant AFACS reduction with PUFA vs controls (OR 0.84, 95% CI 0.71–0.99, p = 0.03), although this effect was found only in CABG and not valve surgery [88]. This appears to be a promising intervention for AF prophylaxis, which may incur few risks from adverse effects and costs, but has not been addressed by any guidelines to date.…”

Section: Preventative Strategies and Associated Evidence Basementioning

confidence: 99%

New-Onset Atrial Fibrillation in Adult Patients After Cardiac Surgery

Burrage

Low

Campbell

et al. 2019

Curr Anesthesiol Rep

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Purpose of Review An overview of recent literature regarding pathophysiology, risk factors, prophylaxis, and treatment of new-onset atrial fibrillation (AF) in post-cardiac surgical patients. Recent Findings AF is the most frequent adverse event after cardiac surgery with significant associated morbidity, mortality, and financial cost. Its causes are multifactorial, and models to stratify patients into risk categories are progressing but a consistent, evidence-based system has not yet been developed. Pharmacologic and surgical interventions to prevent and treat this complication have been an area of ongoing research and recent societal guidelines reflect this. Summary Inconsistencies remain surrounding how to best identify higher-risk AF patients, which interventions should be used to prevent and treat AF, and which patient groups should receive these interventions. The evidence for these available strategies and their place in contemporary guidelines are summarized.

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Section: Preventative Strategies and Associated Evidence Basementioning

confidence: 99%

New-Onset Atrial Fibrillation in Adult Patients After Cardiac Surgery

Burrage

Low

Campbell

et al. 2019

Curr Anesthesiol Rep

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“…Omega-3 fatty acids (Omega-3s) are long-chain, polyunsaturated fatty acids, which include eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), mainly obtained from fish 45 . There is evidence on the usefulness of omega-3s supplementation in cardiovascular mortality, myocardial ischemia, and AFACS.…”

Section: Omega-3 Fatty Acidsmentioning

confidence: 99%

“…In the subgroup analysis, the incidence of PAF was lower in patients who received omega-3s whose EPA/DHA composition was lower than 1 and in patients with revascularization procedures. The number needed to treat was 25 45 . From the authors' point of view, omega-3 fatty acids are part of the third-line prophylactic treatment for the prevention of AFACS.…”

Section: Omega-3 Fatty Acidsmentioning

confidence: 99%

Atrial fibrillation in cardiac surgery

Baeza-Herrera¹,

Rojas‐Velasco²,

Márquez-Murillo³

et al. 2020

ACME

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Atrial fibrillation (AF) is the most frequent arrhythmia in the post-operative period of cardiac surgery. It is associated with heart failure, renal insufficiency, systemic embolism, and increase in days of in-hospital and mortality. AF in the post-operative period of cardiac surgery (FAPCC) usually appears in the first 48 h after surgery. The main mechanisms involved in the appearance and maintenance of FAPCC are the increase in sympathetic tone and the inflammatory response. The associated risk factors are advanced age, chronic obstructive pulmonary disease, chronic kidney disease, valve surgery, fraction of ejection of the left ventricle < 40%, and the withdrawal of β-blocker (BB) drugs. There are instruments that have been shown to predict the appearance of FAPCC. Prophylactic treatment with BBs and amiodarone is associated with a decrease in the appearance of FAPCC. Given its transient nature, it is suggested that the initial treatment of FAPCC be the heart rate control and only if the treatment does not achieve a return to sinus rhythm, the use of electrical cardioversion is suggested. It is unknown what should be the long-term follow-up and complications beyond this period are little known. FAPCC is not a benign or isolated arrhythmia in patients undergoing cardiac surgery, so the identification of risk factors, their prevention, and follow-up in the outpatient setting, should be part of the units dedicated to the care and care of these patients.

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“…In the last decade, ω-3 PUFA have become an important ally in postoperative inflammation and metabolic control in cardiovascular surgery, as it is directly related to a reduction in proinflammatory cytokines and incidence of postoperative arrhythmia, particularly postoperative atrial fibrillation. The protective effects of this type of fish oil have also been observed in critically ill patients in the intensive care unit, usually in parenteral nutrition regimens [5,6] .…”

mentioning

confidence: 99%

“…Results showed that perioperative infusions significantly increased the concentration of ω-3 PUFA in platelet membrane and atrial tissue within 12 hours of the first infusion and significantly lowered clinical and biological signs of inflammation. In a recent meta-analysis (14 studies) on the use of ω-3 PUFA, Wang et al [6] showed promising results, with a lower incidence of POAF (RR 0.84 [95% CI 0.73-0.98], P =0.03). These results, however, were only for coronary artery bypass grafting (0.68 [0.47-0.97], P =0.03); none of the other types of surgery analyzed showed similar results.…”

mentioning

confidence: 99%