title: n-3 polyunsaturated fatty acids in the prevention of atrial fibrillation recurrences after electrical cardioversion: a prospective, randomized study.
abstract: BACKGROUND
  n-3 polyunsaturated fatty acids (n-3 PUFAs) exert antiarrhythmic effects and reduce sudden cardiac death. However, their role in the prevention of atrial fibrillation remains controversial. We aimed to determine the effect of n-3 PUFAs in addition to amiodarone and a renin-angiotensin-aldosterone system inhibitor on the maintenance of sinus rhythm after direct current cardioversion in patients with persistent atrial fibrillation.
  
  
  RESULTS
  We conducted a randomized, double-blind, placebo-controlled, parallel-arm trial in patients with persistent atrial fibrillation, with at least 1 relapse after cardioversion, and treated with amiodarone and a renin-angiotensin-aldosterone system inhibitor. Participants were assigned to placebo or n-3 PUFAs 2 g/d and then underwent direct current cardioversion 4 weeks later. The primary end point was the probability of maintenance of sinus rhythm at 1 year after cardioversion. Of 254 screened patients, 199 were found to be eligible and randomized. At the 1-year follow up, the probability of maintenance of sinus rhythm was significantly higher in the n-3 PUFAs-treated patients compared with the placebo group (hazard ratio, 0.62 [95% confidence interval, 0.52 to 0.72] and 0.36 [95% confidence interval, 0.26 to 0.46], respectively; P=0.0001).
  
  
  CONCLUSIONS
  In patients with persistent atrial fibrillation on amiodarone and a renin-angiotensin-aldosterone system inhibitor, the addition of n-3 PUFAs 2 g/d improves the probability of the maintenance of sinus rhythm after direct current cardioversion. Our data suggest that n-3 PUFAs may exert beneficial effects in the prevention of atrial fibrillation recurrence. Further studies are needed to confirm and expand our findings. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT01198275.
authors.affiliation: Department of Experimental and Applied Medicine, Section of Cardiovascular Diseases, University of Brescia Medical School, P. le Spedali Civili, 1-25123 Brescia, Italy.
authors.forename: Savina
authors.initials: S
authors.lastname: Nodari
authors.forename: Marco
authors.initials: M
authors.lastname: Triggiani
authors.forename: Umberto
authors.initials: U
authors.lastname: Campia
authors.forename: Alessandra
authors.initials: A
authors.lastname: Manerba
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Milesi
authors.forename: Bruno M
authors.initials: BM
authors.lastname: Cesana
authors.forename: Mihai
authors.initials: M
authors.lastname: Gheorghiade
authors.forename: Livio
authors.initials: L
authors.lastname: Dei Cas
mesh_terms: D000368:Aged; D000638:Amiodarone / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000517:prevention & control*; D002908:Chronic Disease; D004554:Electric Countershock; D015525:Fatty Acids, Omega-3 / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012084:Renin-Angiotensin System / Q000187:drug effects; D055502:Secondary Prevention; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents; D015525:Fatty Acids, Omega-3; D000638:Amiodarone