Using omega-3 fatty acids to treat persistent atrial fibrillation: Time to fish or cut bait?

Abstract

r t Recently, Kowey et al performed a controlled, prospecive, multicenter, randomized clinical trial comparing precription-grade omega-3 fatty acids (PUFAs) from fish oil o placebo to determine efficacy in preventing recurrent ymptomatic paroxysmal or persistent atrial fibrillation AF). Fish oil was ineffective when given at a dose of 8 g/d or a week followed by 4 g/d through week 24. For the 105 atients randomized with persistent AF, 33% (n 18) in the lacebo group and 50% (n 32) in the fish oil group had documented recurrent symptomatic AF. In a prior commentary, I (B.O.) stated: “It is safe to say, based on this wellcontrolled rather definitive randomized clinical trial, that PUFAs have no role in the management of recurrent symptomatic atrial fibrillation.” Similar results suggesting no enefit were found in another randomized trial and in a trial valuating the prevention of new-onset AF in the postopertive period, although data from an open-label study showed diametrically opposite results. A meta-analysis inicated no benefit from PUFAs to prevent AF. Since then, in contradistinction to these “rather definitive” data, Nodari et al reported results from a recent ouble-blind placebo-controlled study showing that PUFAs lus amiodarone conferred long-term benefit for patients ith persistent AF. Now, Kumar et al find that PUFA upplementation reduced recurrent persistent AF after carioversion. At 90 days, 38.5% of the PUFA group vs 77.5% f the control group had a recurrence of persistent AF. Not nly did more patients in the PUFA group have pharmacologic eversion to sinus rhythm compared with controls (12.1% vs .4%; P .05), but those who underwent electrical cardioverion did substantially better as well. The mean time to persisent AF recurrence was 190 days in the PUFA group vs 77 ays in the control group (P .001). The median time to ecurrence was 201 days in the PUFA group compared with 32 ays in the control group. This is nearly 7 times better. These ndings were strengthened by longer AF duration and lesser