Table 1: Effect of n-3 Polyunsaturated Fatty Acids on Atrial Fibrillation.
| Study | Patients | Design (Dose), Comparator | Follow-up | End Point | Results |
|---|---|---|---|---|---|
| Persistent or Paroxysmal Atrial Fibrillation | |||||
| FORWARD[24] (2012) | 586 | Double blind (1 g day), placebo | 12 months | Symptomatic AF recurrences | HR (95 % CI) 1.28 (0.90–1.83) |
| Erdogan et al.[29] (2007) | 108 | Triple blind (N/A), placebo | 12 months | Relapse of AF | RR* (95 % CI) 0.89 (0.74–1.07) |
| Margos et al.[53] (2007) | 40 | Open label (N/A) | 6 months | Persistent AF | RR* (95 % CI) 0.88 (0.39–1.95) |
| Bianconi et al.[28] (2011) | 204 | Double blind (1.7 g mean daily), placebo | 6 months | AF recurrences | 51.1 % pl versus 58.9 %n-3 PUFA; p=0.28 |
| Kowey et al.[26] (2010) | 663 | Double blind (3.4 g mean daily), placebo | 6 months | Symptomatic AF/flutter recurrences | HR (95 % CI) 1.22 (0.98–1.52) |
| Özaydin et al.[54] (2011) | 47 | Open label (N/A) | 12 months | AF recurrences >10 minutes | 37.5 % pl versus 39.1 %n-3 PUFA; p=1 |
| Nodari et al.[27] (2011) | 205 | Double blind (1.7 g mean daily), placebo | 12 months | Sinus rhythm maintenance | HR (95 % CI) 0.62 (0.52–0.72) |
| Kumar et al.[55] (2011) | 182 | Open label (1.74 g day) | 12 months | Persistent AF recurrences | HR (95 % CI) 0.385 (0.27–0.56) |
| Nigam et al.[34] (2014) | 337 | Double blind (4 g day), placebo | 6 months | AF recurrences >30 seconds | HR (95 % CI) 1.10 (0.84–1.45) |
| Post–operative Atrial Fibrillation | |||||
| Calò et al.[38] (2005) | 160 | Open label (1.7 g mean daily) | In hospital | AF >5 minutes or requiring intervention | OR (95 % CI)0.35 (0.16–0.76) |
| Heidt et al.[39] (2009) | 102 | Double blind (100 mg/kg per day intravenous), placebo | ICU stay | AF >15 minutes | RR* (95 % CI)0.58 (0.28–1.20) |
| Saravanan et al.[41] (2010) | 103 | Double blind (2 g day), placebo | In hospital | AF ≥30 seconds | 35 % pl vs 42 % n-3 PUFA, χ2=0.60 |
| Heidarsdottir et al.[40] (2010) | 168 | Double blind (2.2 g day), placebo | In hospital (maximum 2 weeks) | AF >5 minutes | 54.2 % pl versus 54.1 %n-PUFA; p=0.99 |
| Sorice et al.[43] (2011) | 201 | Open label (2 g day) | In hospital | AF >5 minutes or requiring intervention | OR (95 % CI) 0.43 (0.20–0.95) |
| Farquharson et al.[44] (2011) | 194 | Double blind (4.5 g day), placebo | In hospital (maximum 6 days) | AF/flutter ≥10 minutes or requiring intervention | OR (95 % CI) 0.70 (0.39–1.28) |
| Sandesara et al.[42] (2012) | 243 | Double blind (2 g day), placebo | 2 weeks | Documented AF requiring intervention | OR (95 % CI) 0.89 (0.52–1.53) |
| OPERA[45] (2012) | 1,516 | Double blind (2 g day), placebo | In hospital | AF ≥30 seconds (ECG or rhythm strips) | OR (95 % CI) 0.96 (0.77–1.20) |
*Data on relative risk (RR) are taken from a meta-analysis of Mariani et al.[33] AF = atrial fibrillation; CI = confidence interval; ECG = electrocardiogram; HR = hazard ratio; ICU = intensive care unit; OR = odds ratio; pl = placebo; PUFA = polyunsaturated fatty acids.