Omega-3 Fatty Acids for the Prevention of Recurrent Symptomatic Atrial Fibrillation

Macchia, Alejandro; Grancelli, Hugo; Varini, Sergio; Nul, Daniel; Laffaye, Nicolás; Mariani, Javier; Ferrante, Daniel; Badra, Raúl; Figal, J.; Ramos, Silvina; Tognoni, Gianni; Doval, Hernán C.

doi:10.1016/j.jacc.2012.11.021

Cited by 119 publications

(45 citation statements)

References 12 publications

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“…8, 9, 20, 21 Our findings that n3-PUFAs as adjunctive therapy did not prevent recurrence of AF are, however, concordant with studies in postoperative AF, 22, 23 and several randomized controlled clinical trials of persistent or paroxysmal AF 10, 13, 14 , as well as a recent meta-analysis. 24 Clinical trials of n3-PUFAs to prevent AF recurrence used a range of doses and differed in design.…”

Section: Discussionsupporting

confidence: 87%

Effect of Omega-Three Polyunsaturated Fatty Acids on Inflammation, Oxidative Stress, and Recurrence of Atrial Fibrillation

Darghosian

Free

et al. 2015

The American Journal of Cardiology

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The efficacy of n-3 PUFAs in preventing recurrence of atrial fibrillation (AF) is controversial and their effects on inflammation and oxidative stress in this population are not known. This study examined the effects of high-dose marine omega-3 polyunsaturated fatty acids (n-3 PUFAs) added to conventional therapy on the recurrence of AF and on markers of inflammation and oxidative stress. Patients with paroxysmal or persistent AF were randomized to n-3 PUFAs (4g/d) (n=126) or placebo (n=64) in a 2:1 ratio in a prospective, double-blind, placebo-controlled, parallel group study. The primary outcome was time to recurrence of AF. Secondary outcomes were changes in biomarkers of inflammation (serum interleukin (IL)-6, IL-8, IL-10, tissue necrosis factor alpha (TNFα), monocyte chemoattractant protein-1 (MCP-1), and vascular endothelial growth factor (VEGF)), N-terminal-pro-brain type natriuretic peptide (NTpBNP), and oxidative stress (urinary F2–isoprostanes (IsoPs)). Atrial fibrillation recurred in 74 (58.7%) patients randomized to n3-PUFAs and in 30 (46.9%) who received placebo; time to recurrence of AF did not differ significantly in the two groups (hazard ratio 1.20; 95% CI 0.76 - 1.90, adjusted P=0.438). Compared to placebo, n3-PUFAs did not result in clinically meaningful changes in concentrations of inflammatory markers, NTpBNP or F2-Isops. In conclusion, in patients with paroxysmal or persistent AF treatment with n3-PUFAs 4g/day did not reduce the recurrence of AF, nor was it associated with clinically important effects on concentrations of markers of inflammation and oxidative stress.

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Section: Discussionsupporting

confidence: 87%

Effect of Omega-Three Polyunsaturated Fatty Acids on Inflammation, Oxidative Stress, and Recurrence of Atrial Fibrillation

Darghosian

Free

et al. 2015

The American Journal of Cardiology

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“…A number of prospective trials investigating ARBs and polyunsaturated fatty acids for prevention of recurrent AF have been disappointing (81, 383-388). Although upstream therapies may be valuable strategies for primary prevention of cardiac changes leading to AF in selected patients, reversal of AF substrate has not been demonstrated and such therapy is not recommended for the prevention of AF recurrence in patients without another indication.…”

Section: Rhythm Controlmentioning

confidence: 99%

2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation

January¹,

Wann²,

Alpert³

et al. 2014

Circulation

3,581

1,139

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“…Eight studies (n=1990 patients) evaluated n‐3 PUFA effects on AF recurrence among patients with reverted persistent or paroxysmal AF. 32–39 The other 8 trials (n=2687 patients) evaluated the effects on postoperative AF. 40–47 …”

Section: Resultsmentioning

confidence: 99%

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

Mariani¹,

Doval²,

Nul³

et al. 2013

JAHA

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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.

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Omega-3 Fatty Acids for the Prevention of Recurrent Symptomatic Atrial Fibrillation

Abstract: Pharmacological supplementation with 1 g of n-3 PUFA for 1 year did not reduce recurrent AF. (Randomized Trial to Assess Efficacy of PUFA for the Maintenance of Sinus Rhythm in Persistent Atrial Fibrillation [FORWARD]; NCT00597220).

Cited by 119 publications

References 12 publications

Effect of Omega-Three Polyunsaturated Fatty Acids on Inflammation, Oxidative Stress, and Recurrence of Atrial Fibrillation

Effect of Omega-Three Polyunsaturated Fatty Acids on Inflammation, Oxidative Stress, and Recurrence of Atrial Fibrillation

2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation

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

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