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Meta-Analysis
. 2013 Feb 19;2(1):e005033.
doi: 10.1161/JAHA.112.005033.

N-3 polyunsaturated fatty acids to prevent atrial fibrillation: updated systematic review and meta-analysis of randomized controlled trials

Javier Mariani  1 , Hernán C Doval, Daniel Nul, Sergio Varini, Hugo Grancelli, Daniel Ferrante, Gianni Tognoni, Alejandro Macchia
Affiliations
Meta-Analysis

N-3 polyunsaturated fatty acids to prevent atrial fibrillation: updated systematic review and meta-analysis of randomized controlled trials

Javier Mariani et al. J Am Heart Assoc. .

Abstract

Background: Previous 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 results: Electronic 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; I(2), 72%) or on postoperative AF (0.86; 95% CI, 0.71 to 1.04; I(2), 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).

Conclusions: Published clinical trials do not support n-3 PUFAs as agents aimed at preventing either postoperative or recurrent AF.

Clinical trial registration: URL: http://www.crd.york.ac.uk/PROSPERO. Unique Identifier: CRD42012002199.

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Figures

Figure 1.
Figure 1.
Studies flow.
Figure 2.
Figure 2.
Effects of n‐3 PUFA on AF. PUFA indicates polyunsaturated fatty acid; AF, atrial fibrillation; RR, relative risk.
Figure 3.
Figure 3.
Effects of n‐3 PUFA on mortality. PUFA indicates polyunsaturated fatty acid; AF, atrial fibrillation; RR, relative risk.
Figure 4.
Figure 4.
Effects of n‐3 PUFA on length of stay among postoperative AF trials. PUFA indicates polyunsaturated fatty acid; AF, atrial fibrillation; WMD, weighted mean difference; CI, confidence interval.
Figure 5.
Figure 5.
Publication bias assessment. AF indicates atrial fibrillation.
Figure 6.
Figure 6.
Meta‐regression of recurrent AF studies. AF indicates atrial fibrillation; PUFA, polyunsaturated fatty acid.
Figure 7.
Figure 7.
Meta‐regression of postoperative AF studies. AF indicates atrial fibrillation; PUFA, polyunsaturated fatty acid.
See this image and copyright information in PMC

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