Table 4.

Other studies on marine n−3 PUFA and atrial fibrillation.

	Study population	n	Study design	Exposure	Duration of exposure	Outcome	Follow-up	Monitoring AF events	Main results
Biscione et al. (2005), Italy	Patients with dual-chamber pacemakers	40	Open-label serial intervention with n−3 PUFA	1 g n−3 PUFA/day	4 months	Number of episodes and burden of atrial tachyarrhythmia	n/a	Open-label serial intervention with n−3 PUFA and observation by pacemaker interrogation before treatment, after 4 months of treatment, and after 4 months of withdrawal	Reduction in number of episodes and burden of atrial tachyarrhythmia for the n−3 treatment period, compared to before and after. Pre-treatment period number of episodes 444 ± 1161 and the burden 3.89% of time; in the n−3 treatment period respectively 181 ± 436 (−59%, p = 0.037), and 1.06% (−67%, p = 0.029). After n−3 withdrawal, the episodes of atrial tachyarrhythmia increased to 552 ± 1717 (p = 0.065) and the burden to 2.69% (p = 0.003)
Patel et al. (2009), US	Comparison of patients taking fish oil supplements 1 month prior to ablation and during follow-up period vs. controls	258	Nested case–control study	≥0.665 g of fish oil	n/a	Recurrence of AF	Up to 60 months	Rhythm transmission three times daily first 5 months. 24-h Holter monitoring at 3, 6, 9, 12 months, and every 6 months hereafter.	Patients taking fish oil supplements had less early recurrence of AF within 8 weeks (27 vs. 44%, p < 0.001) as well as less late recurrence of AF after 8 weeks (23 vs. 32%, p < 0.003)
Kumar et al. (2011b), Australia	Patients undergoing pulmonary vein isolation	36	Unblinded, randomized study	1.8 g n−3 PUFA/day	≥30 days prior to procedure	Parameters of left atrial electrophysiology	None	n/a	The n−3 group exhibited prolonged pulmonary venous and left atrial effective refractory periods and decreased susceptibility to initiation AF from within the pulmonary veins
Kumar et al. (2011a), Australia	Patients undergoing electrophysiological study for supraventricular arrhythmias	61	Single-blinded RCT	1.8 g n−3 PUFA/day	≥30 days before procedure	Parameters of atrial electrophysiology	None	n/a	Chronic fish oil supplementation prolonged atrial refractoriness and reduced vulnerability to inducible AF
Skuladottir et al. (2011), Iceland	Patients from the RCT by Heidarsdottir undergoing CABG and who were randomized to n−3 PUFA or placebo 5–7 days prior to surgery	125	Observational study based on data from RCT	Plasma content of n−3 and n−6 fatty acids	n/a	Post-operative AF ≥ 5 min	None	Continuous ECG	Results suggestive of a U-curved relationship between quartiles of plasma n−3 PUFA and post-operative AF with the lowest incidence in the second quartile in a population with high background intake. Arachidonic acid was associated with a reduced risk of post-operative AF

AF, atrial fibrillation; n−3 PUFA, marine n−3 polyunsaturated fatty acids; RCT, randomized controlled trial; ECG, electrocardiogram; CABG, coronary artery bypass graft surgery.