title: Fish oil for the reduction of atrial fibrillation recurrence, inflammation, and oxidative stress.
abstract: BACKGROUND
  Recent trials of fish oil for the prevention of atrial fibrillation (AF) recurrence have provided mixed results. Notable uncertainties in the existing evidence base include the roles of high-dose fish oil, inflammation, and oxidative stress in patients with paroxysmal or persistent AF not receiving conventional antiarrhythmic (AA) therapy.
  
  
  OBJECTIVE
  The aim of this study was to evaluate the influence of high-dose fish oil on AF recurrence, inflammation, and oxidative stress parameters.
  
  
  METHODS
  We performed a double-blind, randomized, placebo-controlled, parallel-arm study in 337 patients with symptomatic paroxysmal or persistent AF within 6 months of enrollment. Patients were randomized to fish oil (4 g/day) or placebo and followed, on average, for 271 ± 129 days.
  
  
  RESULTS
  The primary endpoint was time to first symptomatic or asymptomatic AF recurrence lasting >30 s. Secondary endpoints were high-sensitivity C-reactive protein (hs-CRP) and myeloperoxidase (MPO). The primary endpoint occurred in 64.1% of patients in the fish oil arm and 63.2% of patients in the placebo arm (hazard ratio: 1.10; 95% confidence interval: 0.84 to 1.45; p = 0.48). hs-CRP and MPO were within normal limits at baseline and decreased to a similar degree at 6 months (Δhs-CRP, 11% vs. -11%; ΔMPO, -5% vs. -9% for fish oil vs. placebo, respectively; p value for interaction = NS).
  
  
  CONCLUSIONS
  High-dose fish oil does not reduce AF recurrence in patients with a history of AF not receiving conventional AA therapy. Furthermore, fish oil does not reduce inflammation or oxidative stress markers in this population, which may explain its lack of efficacy. (Multi-center Study to Evaluate the Effect of N-3 Fatty Acids [OMEGA-3] on Arrhythmia Recurrence in Atrial Fibrillation [AFFORD]; NCT01235130).
authors.affiliation: Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal Heart Institute Research Center, Montreal, Quebec, Canada. Electronic address: anil.nigam@icm-mhi.org.
authors.forename: Anil
authors.initials: A
authors.lastname: Nigam
authors.affiliation: Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal Heart Institute Research Center, Montreal, Quebec, Canada.
authors.forename: Mario
authors.initials: M
authors.lastname: Talajic
authors.affiliation: Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal Heart Institute Research Center, Montreal, Quebec, Canada.
authors.forename: Denis
authors.initials: D
authors.lastname: Roy
authors.affiliation: Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal Heart Institute Research Center, Montreal, Quebec, Canada.
authors.forename: Stanley
authors.initials: S
authors.lastname: Nattel
authors.affiliation: Coordinating Center and Université de Montréal, Montreal, Quebec, Canada.
authors.forename: Jean
authors.initials: J
authors.lastname: Lambert
authors.affiliation: Coordinating Center and Université de Montréal, Montreal, Quebec, Canada.
authors.forename: Anna
authors.initials: A
authors.lastname: Nozza
authors.affiliation: Richardson Centre for Functional Foods and Nutraceuticals, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Peter
authors.initials: P
authors.lastname: Jones
authors.affiliation: Richardson Centre for Functional Foods and Nutraceuticals, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Vanu R
authors.initials: VR
authors.lastname: Ramprasath
authors.affiliation: Department of Cardiology, Quebec Heart and Lung Institute, Quebec, Quebec, Canada.
authors.forename: Gilles
authors.initials: G
authors.lastname: O'Hara
authors.affiliation: Division of Cardiology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Stephen
authors.initials: S
authors.lastname: Kopecky
authors.affiliation: McGill University Health Centre, Montreal, Quebec.
authors.forename: James M
authors.initials: JM
authors.lastname: Brophy
authors.affiliation: Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal Heart Institute Research Center, Montreal, Quebec, Canada.
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Tardif
mesh_terms: D000368:Aged; D000818:Animals; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy*; D002097:C-Reactive Protein / Q000378:metabolism; D019587:Dietary Supplements; D004311:Double-Blind Method; D015525:Fatty Acids, Omega-3 / Q000627:therapeutic use; D005260:Female; D005395:Fish Oils / Q000627:therapeutic use*; D005399:Fishes; D006801:Humans; D007249:Inflammation / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D018384:Oxidative Stress; D009195:Peroxidase / Q000097:blood; D016016:Proportional Hazards Models; D012008:Recurrence; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents; D015525:Fatty Acids, Omega-3; D005395:Fish Oils; D002097:C-Reactive Protein; D009195:Peroxidase
keywords: arrhythmia; fibrillation; inflammation; omega-3 fatty acids; oxidative stress