title: N-3 polyunsaturated fatty acids to prevent atrial fibrillation: updated systematic review and meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  Previous studies have suggested that n-3 polyunsaturated fatty acids (n-3 PUFAs) have antiarrhythmic effects on atrial fibrillation (AF). We aimed to assess the effects of therapy with n-3 PUFAs on the incidence of recurrent AF and on postoperative AF.
  
  
  RESULTS
  Electronic searches were conducted in Web of Science, Medline, Biological Abstracts, Journal Citation Reports, and the Cochrane Central Register of Controlled Trials databases. In addition, data from the recently completed FORωARD and OPERA trials were included. We included randomized controlled trials comparing treatment with n-3 PUFAs versus control to (1) prevent recurrent AF in patients who underwent reversion of AF or (2) prevent incident postoperative AF after cardiac surgery. Of identified studies, 12.9% (16 of 124) were included, providing data on 4677 patients. Eight studies (1990 patients) evaluated n-3 PUFA effects on AF recurrence among patients with reverted AF and 8 trials (2687 patients) on postoperative AF. Pooled risk ratios through random-effects models showed no significant effects on AF recurrence (RR, 0.95; 95% CI, 0.79 to 1.13; I(2), 72%) or on postoperative AF (0.86; 95% CI, 0.71 to 1.04; I(2), 53.1%). A funnel plot suggested publication bias among postoperative trials but not among persistent AF trials. Meta-regression analysis did not find any relationship between doses and effects (P=0.887 and 0.833 for recurrent and postoperative AF, respectively).
  
  
  CONCLUSIONS
  Published clinical trials do not support n-3 PUFAs as agents aimed at preventing either postoperative or recurrent AF.
  
  
  BACKGROUND
  URL: http://www.crd.york.ac.uk/PROSPERO. Unique Identifier: CRD42012002199.
authors.affiliation: Fundación GESICA (Grupo de Estudio de Investigacíon Clínica en Argentina), Buenos Aires, Argentina.
authors.forename: Javier
authors.initials: J
authors.lastname: Mariani
authors.forename: Hernán C
authors.initials: HC
authors.lastname: Doval
authors.forename: Daniel
authors.initials: D
authors.lastname: Nul
authors.forename: Sergio
authors.initials: S
authors.lastname: Varini
authors.forename: Hugo
authors.initials: H
authors.lastname: Grancelli
authors.forename: Daniel
authors.initials: D
authors.lastname: Ferrante
authors.forename: Gianni
authors.initials: G
authors.lastname: Tognoni
authors.forename: Alejandro
authors.initials: A
authors.lastname: Macchia
mesh_terms: D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000453:epidemiology / Q000517:prevention & control*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D019587:Dietary Supplements; D015525:Fatty Acids, Omega-3 / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D012307:Risk Factors; D055502:Secondary Prevention / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents; D015525:Fatty Acids, Omega-3