Long-Term Omega-3 Polyunsaturated Fatty Acid Supplementation Reduces the Recurrence of Persistent Atrial Fibrillation After Electrical Cardioversion

Study Questions:

Does fish oil prevent recurrent atrial fibrillation (AF) after cardioversion?

Methods:

One hundred seventy-eight patients (mean age 62 years) with persistent AF were randomly assigned to an omega-3 group (6 g/day of fish oil for ≥1 month prior to cardioversion, n = 91) or to a control group (n = 87). Concurrent therapy with sotalol or amiodarone was permitted in both groups. In the omega-3 group, treatment with fish oil was continued for 1 year or until AF recurred. The patients were followed at regular intervals for 1 year post-cardioversion. The primary endpoint was recurrence of AF.

Results:

Forty-five percent of patients were treated with sotalol and 33% with amiodarone, with no differences in concurrent drug therapy between the two study arms. In the omega-3 group, patients received fish oil for a mean of 56 days before cardioversion. The 90-day AF recurrence rate after cardioversion was significantly lower in the omega-3 group (38.5%) than in the control group (77.5%), as was the 1-year AF recurrence rate (67% vs. 90%, respectively). The effect of fish oil on recurrent AF was independent of concurrent antiarrhythmic drug therapy.

Conclusions:

The authors concluded that pretreatment with fish oil reduces the probability of recurrent AF after electrical cardioversion.

Perspective:

Prior studies of fish oil for AF prevention have had conflicting results, possibly because of variability between studies in dosage and duration of pretreatment. Long-term fish oil administration results in prolongation of atrial refractoriness and downregulation of profibrillatory cardiac connexins and proinflammatory cytokines. The results of this study suggest that ≥1 month of treatment with 6 g/day is sufficient for the antiarrhythmic effects of fish oil to become manifest.

Clinical Topics: Dyslipidemia, Prevention, Lipid Metabolism, Nonstatins, Diet

Keywords: Fish Oils, Dietary Supplements, Fatty Acids


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