Omega 3 and atrial fibrillation: Where are we?

Table 2 Principal clinical studies investigating the effect of n-3 poly-unsaturated fatty acids on post-operative atrial fibrillation

Study design	Population	PUFA administration	PUFA quantification	AF diagnosis	Results
Randomized, open label[14]	160 CABG pts; age: 66.2 yr; Italy; BB approximately 57%; statins approximately 58%	N-3 PUFA 2 g/d (EPA/DHA: 1:2) ≥ 5 d before CS, until discharge vs not	No PUFA dosage	Continuous 5 d monitoring + daily ECG up to discharge. AF: > 5 min/requiring therapy	Lower AF risk. P = 0.013
Prospective observational[15]	530 CS pts; age: 66.4 yr; Italy. BB: 53%; statins: 46%	N-3 PUFA 1 g/d (EPA/DHA: 0.9:1.5) 5 d pre-CS vs not	No PUFA dosage	Continuous monitoring during ICU-stay. AF: ≥ 5 min	Lower POAF during ICU stay. P = 0.006
Double blind-RCT[16]	102 CABG pts; age: 67 yr; Germany	Iv 100 mg fish oil/kg per day during ICU-stay vs soya oil	No PUFA dosage	Continuous monitoring during ICU-stay	Lower AF risk with PUFA. P < 0.05
Prospective cohort[19]	125 CABG pts; age: approximately 68 yr; Iceland. BB: 77.4%; statins: 84%	N3-PUFA (EPA/DHA: 1.2:1) 2.2 g/d 7 d pre-CABG vs placebo	PUFA dosage basally, before, 3 d after CS	Continuous monitoring during hospital stay. AF: ≥ 5 min	Positive DHA/POAF association (U-curve relationship)
Double blind-RCT[23]	1516 CS pts; age: 64 yr; Italy-United States-Argentina. BB: 76.9%; statins: 57.5%	N3-PUFA (EPA/DHA: 4.6:3.7) 2 g/d 5 d pre-CS up to discharge vs placebo	Serum PUFA dosage basally, before CS	Continuous 5 d monitoring. AF: ≥ 30 s	No lower AF despite 40% higher plasmatic PUFA
Double blind-RCT[18]	243 CS pts; age: 62.7 yr, United States. BB: 79%; statins: 73%	N-3 PUFA 2 g/d vs corn oil	Basal serum PUFA dosage, before, 3 d post CS	Continuous ECG during hospital stay; FU: 1 mo. AF: Episodes requiring treatment	No lower AF; plasma PUFA increase
Double blind-RCT[20]	170 CS pts; age: 67 yr; Iceland. BB approximately 76%	N3-PUFA (EPA/DHA: 1.2:1) 2 g/d 1 wk before and 2 after CS vs olive oil	Serum DHA, EPA dosage basally, pre 3 d post CS	Continuous monitoring during hospital stay. AF: ≥ 5 min	No lower AF; plasma n-3 PUFA increase
Double blind-RCT[22]	200 CS pts; age: 64 yr; Australia, BB: 43%; statins: 73%	N-3 PUFA oil (EPA/DHA: 2.7:1.9) for 3 wk vs placebo	Dosage of serum PUFA basally, pre-CS; atrial PUFA	Continuous 72 h monitoring. AF/flutter ≥ 10 min/requiring treatment	No lower AF risk; increase in serum and atrial PUFA
Double blind RCT[21]	108 CABG pts; age: 64 yr; United Kingdom; BB: 88%; statins: 98%	N-3 PUFA (EPA/DHA: 1.2:1) 2 g/d for approximately 16 d vs olive oil	Dosage of serum PUFA basally, 3 d post CS; atrial PUFA	Continuous 5 d monitoring + daily ECG. AF: > 30 s	No lower AF risk; higher serum and atrial PUFA

CABG: Coronary artery bypass grafting; pts: Patients; BB: Beta blockers; CS: Cardiac surgery; ICU: Intensive care unit; PUFA: Poly-unsaturated fatty acids; EPA: Eicosapentaenoic acid; DHA: Docosahexaenoic acid; AF: Atrial fibrillation.