title: Prevention of postoperative atrial fibrillation in open heart surgery patients by preoperative supplementation of n-3 polyunsaturated fatty acids: an updated meta-analysis.
abstract: BACKGROUND
  Several randomized clinical trials evaluated whether preoperative supplementation of omega-3 (n-3) polyunsaturated fatty acids protects against postoperative atrial fibrillation after cardiac surgery, a condition associated with increased cardiac and cerebral mortality. However, their efficacy remains still controversial. An updated meta-analysis was performed to clarify if preoperative n-3 polyunsaturated fatty acid supplementation prevents postoperative atrial fibrillation in patients undergoing cardiac surgery.
  
  
  METHODS
  Articles were retrieved until November 2012 by screening electronic databases (PubMed, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials) and cross references. Two of us independently reviewed articles and agreed to select 8 randomized clinical trials. For each study, the incidence of atrial fibrillation in both the intervention and placebo groups was extracted to calculate odd ratio and 95% confidence intervals (CIs). Weighted study-specific estimates were combined using fixed (Mantel-Haenszel method) and random-effects (DerSimonian-Laird method) models.
  
  
  RESULTS
  This meta-analysis includes 2687 patients (1337 in the intervention group) who underwent cardiac surgery. Pooled analysis using fixed-effects models showed a significant reduction (average, 16%; 95% CI, 1%-29%) in postoperative atrial fibrillation by preoperative n-3 polyunsaturated fatty acids. There was a low heterogeneity among studies (P = .07 and I(2) = 46%). By using a random-effects model, the reduction averaged 25% (odds ratio, 0.75; 95% CI, 0.57-1.00; P = .05). When isolated coronary artery bypass graft surgery was only considered (7 studies), a significant protection averaging 34% was observed in a fixed model (odds ratio, 0.66; 95% CI, 0.50-0.87; P = .003; I(2) = 26%, P = .23).
  
  
  CONCLUSIONS
  A preoperative supplementation of n-3 polyunsaturated fatty acids significantly prevents the occurrence of postoperative atrial fibrillation in patients undergoing cardiac surgery, in particular coronary artery bypass surgery.
authors.affiliation: Laboratorio di Epidemiologia Genetica ed Ambientale, Laboratori di Ricerca, Fondazione di Ricerca e Cura "Giovanni Paolo II," Università Cattolica, Campobasso, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Costanzo
authors.forename: Veronica
authors.initials: V
authors.lastname: di Niro
authors.forename: Augusto
authors.initials: A
authors.lastname: Di Castelnuovo
authors.forename: Francesco
authors.initials: F
authors.lastname: Gianfagna
authors.forename: Maria Benedetta
authors.initials: MB
authors.lastname: Donati
authors.forename: Giovanni
authors.initials: G
authors.lastname: de Gaetano
authors.forename: Licia
authors.initials: L
authors.lastname: Iacoviello
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D001026:Coronary Artery Bypass / Q000009:adverse effects; D004334:Drug Administration Schedule; D015525:Fatty Acids, Omega-3 / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011300:Preoperative Care; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015525:Fatty Acids, Omega-3
keywords: 23.1; 35.2; AF; CABG; CI; OHS; OR; POAF; PUFA; RCT; atrial fibrillation; confidence interval; coronary artery bypass graft; n-3; odds ratio; omega-3; open heart surgery; polyunsaturated fatty acid; postoperative atrial fibrillation; randomized controlled trial