title: Upstream Treatment of Atrial Fibrillation with n-3 Polyunsaturated Fatty Acids: Myth or Reality?
abstract: Atrial fibrillation (AF) is the most common sustained arrhythmia in adults and is associated with an increased risk of fatal and non-fatal events. Antiarrhythmic drugs provide limited protection against AF recurrence and have a poor safety profile. Several mechanisms have been proven to be involved in AF, e.g. inflammation, oxidative stress, fibrosis and ischaemia. Prevention of AF with interventions that target these mechanisms has emerged as a result of experimental studies suggesting the use of upstream therapies. Long chain n-3 polyunsaturated fatty acids (n-3 PUFA) have multiple effects on cardiac electrophysiology, and epidemiological studies on fish oil suggest a possible use of n-3 PUFA in AF prevention. Several randomised clinical trials have been designed to evaluate the efficacy of n-3 PUFA in preventing AF. In this review, we report the conflicting results of these trials in two different clinical settings: recurrence in patients with history of AF and development of post-operative AF in patient undergoing cardiac surgery.
authors.affiliation: Azienda Ospedaliero-Universitaria Careggi, Section of Geriatric Medicine and Cardiology, Florence, Italy; ANMCO Research Center, Florence, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Orso
authors.affiliation: ANMCO Research Center, Florence, Italy.
authors.forename: Gianna
authors.initials: G
authors.lastname: Fabbri
authors.affiliation: ANMCO Research Center, Florence, Italy.
authors.forename: Aldo Pietro
authors.initials: AP
authors.lastname: Maggioni
keywords: Arrhythmias; atrial fibrillation; n-3 PUFA; post-operative atrial fibrillation; prevention
references.citation: Europace. 2012 Oct;14(10):1385-413
references.pmid: 22923145
references.citation: Heart Rhythm. 2012 Jul;9(7):1115-1122.e4
references.pmid: 22342864
references.citation: J Am Coll Cardiol. 2011 Nov 8;58(20):2047-67
references.pmid: 22051327
references.citation: Am Heart J. 2006 Apr;151(4):771-8
references.pmid: 16569531
references.citation: Circulation. 2007 Nov 6;116(19):2101-9
references.pmid: 17967774
references.citation: Am J Clin Nutr. 1999 Sep;70(3):331-7
references.pmid: 10479194
references.citation: J Am Coll Cardiol. 2014 Dec 2;64(21):e1-76
references.pmid: 24685669
references.citation: J Membr Biol. 2005 Jul;206(2):129-39
references.pmid: 16456723
references.citation: Am J Cardiol. 2011 Sep 15;108(6):851-6
references.pmid: 21762871
references.citation: Circulation. 2011 Sep 6;124(10):1100-6
references.pmid: 21844082
references.citation: JAMA. 2012 Nov 21;308(19):2001-11
references.pmid: 23128104
references.citation: Circulation. 2002 Apr 23;105(16):1897-903
references.pmid: 11997274
references.citation: J Am Coll Cardiol. 2013 Jan 29;61(4):463-8
references.pmid: 23265344
references.citation: Contemp Clin Trials. 2012 Jan;33(1):159-71
references.pmid: 21986389
references.citation: Europace. 2011 Mar;13(3):308-28
references.pmid: 21345926
references.citation: Heart Rhythm. 2012 Apr;9(4):483-91
references.pmid: 22120130
references.citation: Eur J Clin Invest. 2015 Feb;45(2):170-8
references.pmid: 25510286
references.citation: J Am Coll Cardiol. 2013 Oct 15;62(16):1457-65
references.pmid: 23916928
references.citation: Circ Arrhythm Electrophysiol. 2010 Feb;3(1):46-53
references.pmid: 20042769
references.citation: Europace. 2011 Feb;13(2):174-81
references.pmid: 21059740
references.citation: Monaldi Arch Chest Dis. 2011 Jun;76(2):93-8
references.pmid: 22128614
references.citation: Eur J Pharmacol. 1996 Apr 4;300(1-2):83-9
references.pmid: 8741170
references.citation: J Am Coll Cardiol. 2007 Oct 9;50(15):1505-12
references.pmid: 17919572
references.citation: Interact Cardiovasc Thorac Surg. 2014 May;18(5):646-54
references.pmid: 24556447
references.citation: N Engl J Med. 2012 Jan 12;366(2):120-9
references.pmid: 22236222
references.citation: Circulation. 2005 Mar 8;111(9):1100-5
references.pmid: 15723973
references.citation: J Am Heart Assoc. 2012 Jun;1(3):e000547
references.pmid: 23130134
references.citation: Circulation. 1998 Sep 8;98(10):946-52
references.pmid: 9737513
references.citation: J Am Coll Cardiol. 2005 May 17;45(10):1723-8
references.pmid: 15893193
references.citation: Eur J Heart Fail. 2013 Nov;15(11):1289-95
references.pmid: 23839902
references.citation: Am J Clin Nutr. 2005 Jan;81(1):50-4
references.pmid: 15640459
references.citation: J Am Heart Assoc. 2013 Feb 19;2(1):e005033
references.pmid: 23525440
references.citation: Am J Cardiol. 2010 Mar 15;105(6):844-8
references.pmid: 20211329
references.citation: Lancet. 1999 Aug 7;354(9177):447-55
references.pmid: 10465168
references.citation: Heart. 2011 Jul;97(13):1034-40
references.pmid: 21478384
references.citation: J Am Heart Assoc. 2015 May 20;4(5):null
references.pmid: 25994442
references.citation: Br J Pharmacol. 2007 Feb;150(3):281-5
references.pmid: 17179952
references.citation: Circulation. 2004 Jul 27;110(4):368-73
references.pmid: 15262826
references.citation: Europace. 2010 Mar;12(3):356-63
references.pmid: 20061328
references.citation: Can J Cardiol. 2013 Feb;29(2):196-203
references.pmid: 22681963
references.citation: Circulation. 2007 Sep 4;116(10):e320-35
references.pmid: 17768297
references.citation: Anadolu Kardiyol Derg. 2011 Jun;11(4):305-9
references.pmid: 21543294
references.citation: JAMA. 2004 Apr 14;291(14):1720-9
references.pmid: 15082699
references.citation: Pharmacol Ther. 2013 Oct;140(1):53-80
references.pmid: 23735203
references.citation: Circulation. 2000 Mar 28;101(12):1403-8
references.pmid: 10736284
references.citation: J Thorac Cardiovasc Surg. 2013 Oct;146(4):906-11
references.pmid: 23587470
references.citation: Thorac Cardiovasc Surg. 2009 Aug;57(5):276-80
references.pmid: 19629889
references.citation: JAMA. 2010 Dec 1;304(21):2363-72
references.pmid: 21078810
references.citation: J Am Coll Cardiol. 2014 Oct 7;64(14):1441-8
references.pmid: 25277614
references.citation: Circulation. 2009 Dec 8;120(23 ):2315-21
references.pmid: 19933935
references.citation: J Am Coll Nutr. 2012 Feb;31(1):4-13
references.pmid: 22661621
references.citation: Curr Med Chem. 2007;14(19):2070-80
references.pmid: 17691948