title: Omega-3 fatty acids for postoperative atrial fibrillation: alone or in combination with antioxidant vitamins?
abstract: BACKGROUND
  The effects of omega-3 polyunsaturated fatty acids (PUFA) on the prevention of postoperative atrial fibrillation (POAF) are inconclusive in current studies. Moreover, the most appropriate composition of PUFA to play the protective role is unclear. The aim of this meta-analysis was to ascertain the protective role of PUFA on POAF and the most appropriate composition.
  
  
  METHODS
  Studies were identified through PubMed, CENTRAL, EMBASE, reviews and reference lists of relevant papers. The odds ratio (OR) was calculated for POAF. Statistical analyses were performed with Review Manager 5.0.
  
  
  RESULTS
  Eleven randomised controlled trials with 3137 patients were included in the analysis. The use of PUFA alone did not reduce the incidence of POAF compared with the control (OR: 0.76; 95% confidence interval [CI]: 0.57-1.03; P=0.08; I(2)=52%). However, combination therapy with PUFA and vitamins C and E reduced the incidence of POAF by 68% (OR: 0.32; 95%CI: 0.17-0.60; P=0.0005; I(2)=38%). Subgroup analysis indicated that the ratio of EPA/DHA 1:2 was effective in preventing POAF (OR: 0.35; 95%CI: 0.24-0.50; P<0.00001; I(2)=0%), while the ratio not 1:2 failed.
  
  
  CONCLUSIONS
  Combination therapy with PUFA and vitamins C and E is effective in the prevention of POAF while PUFA alone is not. The ratio of EPA/DHA may influence the incidence of POAF, and 1:2 may be most appropriate. Studies about PUFA on the prevention of POAF are still worthwhile to be conducted in the future.
authors.affiliation: Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, 100029, China.
authors.forename: Xue-Yuan
authors.initials: XY
authors.lastname: Guo
authors.affiliation: Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, 100029, China.
authors.forename: Xian-Liang
authors.initials: XL
authors.lastname: Yan
authors.affiliation: Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, 100029, China.
authors.forename: Ying-Wei
authors.initials: YW
authors.lastname: Chen
authors.affiliation: Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, 100029, China.
authors.forename: Ri-Bo
authors.initials: RB
authors.lastname: Tang
authors.affiliation: Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, 100029, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Du
authors.affiliation: Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, 100029, China.
authors.forename: Jian-Zeng
authors.initials: JZ
authors.lastname: Dong
authors.affiliation: Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, 100029, China. Electronic address: chshma@vip.sina.com.
authors.forename: Chang-Sheng
authors.initials: CS
authors.lastname: Ma
mesh_terms: D000975:Antioxidants / Q000627:therapeutic use*; D001205:Ascorbic Acid / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000517:prevention & control*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D015525:Fatty Acids, Omega-3 / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000517:prevention & control*; D039781:PubMed; D016032:Randomized Controlled Trials as Topic; D014810:Vitamin E / Q000627:therapeutic use*; D014815:Vitamins / Q000627:therapeutic use*
chemical_list: D000975:Antioxidants; D015525:Fatty Acids, Omega-3; D014815:Vitamins; D014810:Vitamin E; D001205:Ascorbic Acid
keywords: Inflammation; Meta-analysis.; Omega-3 fatty acids; Postoperative atrial fibrillation; Vitamins