Reply to Letter From Gu et al

Abstract

We thank Gu et al. for their interest in our recent study, titled “Efficacy and Safety of Omega-3 Fatty Acids for the Prevention of Atrial Fibrillation: A Meta-analysis.”1He Z. Yang L. Tian J. Yang K. Wu J. Yao Y. Efficacy and safety of omega-3 fatty acids for the prevention of atrial fibrillation: a meta-analysis.Can J Cardiol. 2013; 29: 196-203Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar The study reported the efficacy and safety of omega-3 fatty acids for the primary and secondary prevention of atrial fibrillation (AF). We found that omega-3 fatty acids therapy was associated with a 34% decreased odds of AF after open heart surgery, but no significant difference in recurrence of AF between omega-3 fatty acids and control groups. First, Gu et al. raised the issue of why only randomized controlled trials reported in full text were included in our meta-analysis, but those randomized controlled trials reported in abstract or meeting proceeding form were not included. The reason was that studies published in abstract form were not submitted for peer review, which may influence the results, heterogeneity, and publication bias (the point has been clarified in the Discussion of our article). Second, Gu et al. remarked that we should use postoperative AF that was defined as lasting ≥ 30 seconds, but not clinical AF data in the included study by Saravanan et al.2Saravanan P. Bridgewater B. West A.L. O'Neill S.C. Calder P.C. Davidson N.C. Omega-3 fatty acid supplementation does not reduce risk of atrial fibrillation after coronary artery bypass surgery: a randomized, double-blind, placebo-controlled clinical trial.Circ Arrhythm Electrophysiol. 2010; 3: 46-53Crossref PubMed Scopus (150) Google Scholar First, until now, there still has not been a common identification criterion on postoperative AF and different studies have varying identification criteria. Second, some of postoperative AF is transient and did not need therapy. As mentioned in the study by Saravanan et al., 51 patients of 103 had at least 1 episode of AF ≥ 30 seconds, but only 40 patients of 103 had clinically recognized AF (as documented by the clinicians involved in the patients' care in the postoperative period) and needed therapy.2Saravanan P. Bridgewater B. West A.L. O'Neill S.C. Calder P.C. Davidson N.C. Omega-3 fatty acid supplementation does not reduce risk of atrial fibrillation after coronary artery bypass surgery: a randomized, double-blind, placebo-controlled clinical trial.Circ Arrhythm Electrophysiol. 2010; 3: 46-53Crossref PubMed Scopus (150) Google Scholar Therefore, clinical AF is more significant in the analysis of the efficacy of omega-3 fatty acids for the prevention of AF. The authors have no conflicts of interest to disclose. Do Omega-3 Fatty Acids Decrease the Incidence of Atrial Fibrillation After Open Heart Surgery?Canadian Journal of CardiologyVol. 29Issue 4PreviewWe congratulate He et al. for their interesting report in a recent issue of the Canadian Journal of Cardiology, regarding the role of omega-3 fatty acids (PUFA) on the prevention of postoperative atrial fibrillation (POAF) in patients undergoing open heart surgery.1 There are some issues which need to be addressed in the article: Thus, we thought that the data on POAF estimated by continuous electrocardiogram monitoring should be used. Using these data, the incidence of POAF was 43% (22/51) in the placebo group and 56% (29/52) in the PUFA group, and the pooled odds ratio was 0.67 (95% confidence interval, 0.43-1.04; P = 0.075; I2 = 55.0%; Fig. Full-Text PDF