title: n-3 Polyunsaturated fatty acids for the prevention of postoperative atrial fibrillation:  a meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  n-3 Polyunsaturated fatty acids (n-3 PUFAs) have been proposed as prophylactic therapy in the prevention of postoperative atrial fibrillation (POAF) in patients undergoing cardiac surgery. We conducted a meta-analysis of randomized controlled trials to better clarify this issue.
  
  
  METHODS
  An electronic database search for randomized controlled trials on the effect of n-3 PUFAS on POAF was conducted, limited to English language publications until December 2010. For each study, data regarding the incidence of POAF were used to generate risk ratio (<1, favors n-3 PUFA; >1, favors placebo). Pooled summary effect estimate was calculated by means of a fixed or random effect according to heterogeneity. Meta-regression was used to investigate the effect of eicosapentaenoic acid (EPA)/docosahexaenoic acid (DHA) ratio and preoperative β-blockers on the effect of n-3 PUFA on POAF.
  
  
  RESULTS
  Three publications were included in the analysis, enrolling a total of 431 patients. Overall incidence of POAF ranged from 24 to 54%. Pooling data, n-3 PUFA did not show a significant effect on the risk of POAF [risk ratio 0.89; 95% confidence interval (CI) 0.55-1.44; P=0.63]. However, meta-regression analysis showed a trend toward a benefit from n-3 PUFA supplementation when the EPA/DHA ratio was 1:2 (Q model=7.4; p model=0.02) and when preoperative β-blocker rate was lower (Q model=8.0; p model=0.01).
  
  
  CONCLUSIONS
  In conclusion, the results of the present meta-analysis of randomized controlled trials suggest that preoperative n-3 PUFA therapy may not reduce POAF in patients undergoing cardiac surgery. However, several aspects may have influenced this negative result, which need to be investigated.
authors.affiliation: Department of Cardiac Surgery, School of Medicine, University of Rome La Sapienza, Via di Grottarossa 1039, Rome, Italy. u2benedetto@libero.it
authors.forename: Umberto
authors.initials: U
authors.lastname: Benedetto
authors.forename: Emiliano
authors.initials: E
authors.lastname: Angeloni
authors.forename: Giovanni
authors.initials: G
authors.lastname: Melina
authors.forename: Tommaso H
authors.initials: TH
authors.lastname: Danesi
authors.forename: Roberta
authors.initials: R
authors.lastname: Di Bartolomeo
authors.forename: Andrea
authors.initials: A
authors.lastname: Lechiancole
authors.forename: Simone
authors.initials: S
authors.lastname: Refice
authors.forename: Antonino
authors.initials: A
authors.lastname: Roscitano
authors.forename: Cosimo
authors.initials: C
authors.lastname: Comito
authors.forename: Riccardo
authors.initials: R
authors.lastname: Sinatra
mesh_terms: D001281:Atrial Fibrillation / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D019587:Dietary Supplements; D015525:Fatty Acids, Omega-3 / Q000008:administration & dosage*; D006801:Humans; D011183:Postoperative Complications; D016032:Randomized Controlled Trials as Topic
chemical_list: D015525:Fatty Acids, Omega-3