N‐3 Polyunsaturated Fatty Acids to Prevent Atrial Fibrillation: Updated Systematic Review and Meta‐Analysis of Randomized Controlled Trials

Abstract

BackgroundPrevious studies have suggested that n‐3 polyunsaturated fatty acids (n‐3 PUFAs) have antiarrhythmic effects on atrial fibrillation (AF). We aimed to assess the effects of therapy with n‐3 PUFAs on the incidence of recurrent AF and on postoperative AF.Methods and ResultsElectronic searches were conducted in Web of Science, Medline, Biological Abstracts, Journal Citation Reports, and the Cochrane Central Register of Controlled Trials databases. In addition, data from the recently completed FORωARD and OPERA trials were included. We included randomized controlled trials comparing treatment with n‐3 PUFAs versus control to (1) prevent recurrent AF in patients who underwent reversion of AF or (2) prevent incident postoperative AF after cardiac surgery. Of identified studies, 12.9% (16 of 124) were included, providing data on 4677 patients. Eight studies (1990 patients) evaluated n‐3 PUFA effects on AF recurrence among patients with reverted AF and 8 trials (2687 patients) on postoperative AF. Pooled risk ratios through random‐effects models showed no significant effects on AF recurrence (RR, 0.95; 95% CI, 0.79 to 1.13; I2, 72%) or on postoperative AF (0.86; 95% CI, 0.71 to 1.04; I2, 53.1%). A funnel plot suggested publication bias among postoperative trials but not among persistent AF trials. Meta‐regression analysis did not find any relationship between doses and effects (P=0.887 and 0.833 for recurrent and postoperative AF, respectively).ConclusionsPublished clinical trials do not support n‐3 PUFAs as agents aimed at preventing either postoperative or recurrent AF.Clinical Trial RegistrationURL: http://www.crd.york.ac.uk/PROSPERO. Unique Identifier: CRD42012002199.

Inflammation, oxidative stress and postoperative atrial fibrillation in cardiac surgery

“…However; different meta-analysis (Mariani, et al, 2013;Mozaffarian, et al, 2013;B. Zhang, Zhen, Tao, Bao, & Zhang, 2014) have confirmed the finding of this trial and showed that perioperative supplementation with n-3-PUFAs compared with placebo did not reduce the risk of POAF.…”

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

“…Inne metody leczenia również oceniano w małych próbach klinicznych generujących nowe hipotezy badawcze, ale nie wykazano jednoznacznie ich korzystnych efektów. Do ocenianych metod należało stosowanie magnezu [925,935,936], wielonienasyconych kwasów tłuszczowych z grupy omega-3 [937][938][939][940][941][942][943][944][945], kolchicyny [946] i glikokortykosteroidów [947,948], a także wycięcie tylnej części osierdzia [949]. Pooperacyjna stymulacja dwuprzedsionkowa narzuconym szybkim rytmem (overdrive) nie znalazła powszechnego zastosowania mimo pewnych danych wskazujących na jej profilaktyczny efekt [925,950].…”

The Pharmacology of the Cytochrome P450 Epoxygenase/Soluble Epoxide Hydrolase Axis in the Vasculature and Cardiovascular Disease

“…For example, the EPA-derived metabolite 17,18-EEQ and the DHAderived 19,20-EDP are highly active antiarrhythmic agents in neonatal rat cardiomyocytes (Arnold et al, 2010;Falck et al, 2011;Westphal et al, 2011). Although a similar effect of preoperative supplementation of v-3 PUFAs was reported on postoperative atrial fibrillation after heart surgery in humans (Haberka et al, 2011;Moertl et al, 2011;Costanzo et al, 2013), these findings were recently questioned (Mozaffarian et al, 2012;Mariani et al, 2013;Fares et al, 2014).…”