title: Effects of n-3 polyunsaturated fatty acids on malignant ventricular arrhythmias in patients with chronic heart failure and implantable cardioverter-defibrillators: A substudy of the Gruppo Italiano per lo Studio della Sopravvivenza nell'Insufficienza Cardiaca (GISSI-HF) trial.
abstract: BACKGROUND
  The antiarrhythmic effects of n-3 polyunsaturated fatty acids (n-3PUFA) in ischemic heart disease have been demonstrated; however, studies in patients surviving malignant ventricular arrhythmias of different etiologies treated with an implantable cardioverter-defibrillator (ICD) have given conflicting results. The purpose of this study was to assess the antiarrhythmic effect of n-3PUFA versus placebo in 566 patients with heart failure enrolled in the GISSI-HF trial who received an ICD for secondary or primary prevention of ventricular fibrillation (VF) or tachycardia (VT).
  
  
  METHODS
  Clinical data and arrhythmic event recordings extracted from the device memory were obtained. We tested the treatment effect by a multivariate Cox model adjusting for all clinical parameters associated with the primary end point defined as time to first appropriate ICD discharge for VT/VF.
  
  
  RESULTS
  In the 566 patients with at least one recorded follow-up visit, 1363 VT and 316 VF episodes were terminated by ICD pacing or shock over a median follow-up of 928 days. The incidence of the primary end point event was 27.3% in the n-3PUFA group and 34.0% in the placebo group (adjusted hazard rate = 0.80, 95% CI 0.59-1.09, P = .152). Patients who received 1, 2 to 3, or >3 ICD discharges were 8.9%, 7.1%, and 11.1% in the n-3PUFA group, compared with slightly higher rates of 11.1%, 10.7%, and 12.1% in the placebo group (overall P = .30). Patients with the highest 3-month increase in plasma n-3PUFA had a somewhat lower incidence of arrhythmic events.
  
  
  CONCLUSIONS
  The results of this study, though not statistically significant, support prior evidences of an antiarrhythmic effect of n-3PUFA in patients with ICD, although they leave open the issue of whether this effect leads to a survival benefit.
authors.affiliation: Unit of Cardiovascular Medicine, Cardiopulmonary Dept, Fondazione Ca' Granda/Policlinico, Milano, Italy.
authors.forename: Andrea A
authors.initials: AA
authors.lastname: Finzi
authors.forename: Roberto
authors.initials: R
authors.lastname: Latini
authors.forename: Simona
authors.initials: S
authors.lastname: Barlera
authors.forename: Maria G
authors.initials: MG
authors.lastname: Rossi
authors.forename: Albarosa
authors.initials: A
authors.lastname: Ruggeri
authors.forename: Alessandro
authors.initials: A
authors.lastname: Mezzani
authors.forename: Chiara
authors.initials: C
authors.lastname: Favero
authors.forename: Maria G
authors.initials: MG
authors.lastname: Franzosi
authors.forename: Domenico
authors.initials: D
authors.lastname: Serra
authors.forename: Donata
authors.initials: D
authors.lastname: Lucci
authors.forename: Francesca
authors.initials: F
authors.lastname: Bianchini
authors.forename: Roberto
authors.initials: R
authors.lastname: Bernasconi
authors.forename: Aldo P
authors.initials: AP
authors.lastname: Maggioni
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Nicolosi
authors.forename: Maurizio
authors.initials: M
authors.lastname: Porcu
authors.forename: Gianni
authors.initials: G
authors.lastname: Tognoni
authors.forename: Luigi
authors.initials: L
authors.lastname: Tavazzi
authors.forename: Roberto
authors.initials: R
authors.lastname: Marchioli
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D017147:Defibrillators, Implantable; D015525:Fatty Acids, Omega-3 / Q000627:therapeutic use*; D005260:Female; D006333:Heart Failure / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D017180:Tachycardia, Ventricular / Q000188:drug therapy / Q000209:etiology* / Q000628:therapy*; D014693:Ventricular Fibrillation / Q000188:drug therapy / Q000209:etiology* / Q000628:therapy*
chemical_list: D015525:Fatty Acids, Omega-3