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Journal of Interventional Cardiac Electrophysiology

Published in:

01-03-2018

N-3 polyunsaturated fatty acids for prevention of postoperative atrial fibrillation: updated meta-analysis and systematic review

Authors: Hao Wang, Jindong Chen, Liang Zhao

Published in: Journal of Interventional Cardiac Electrophysiology | Issue 2/2018

Abstract

Background or purpose

N-3 polyunsaturated fatty acids (PUFA) have been postulated to have an anti-arrhythmic effect on postoperative atrial fibrillation (POAF), with conflicting results among studies. This study on pooled data evaluated the effect of PUFA on POAF among patients undergoing cardiac surgery.

Methods

The Pubmed, EMBASE, and CENTRAL databases were searched without restriction on language for randomized controlled trials on the effect of PUFA on POAF that were published before August 31, 2017. The incidence of POAF was extracted as primary endpoint. Pooled data were assessed by using a random-effects model.

Results

Out of 269 articles identified, 14 studies with 3570 patients were eligible and included in the meta-analysis. PUFA reduced incidence of POAF (RR 0.84 [95% CI 0.73–0.98], P = 0.03). The funnel plot and fail-safe number suggested insignificant publication bias. In sensitivity and subgroup analyses, (1) PUFA was effective in preventing POAF for eicosapentaenoic acid (EPA)/DHA < 1 (0.51 [0.36–0.73], P = 0.0003) but not EPA/DHA > 1 or unknown; (2) the efficacy in reducing POAF was apparent when placebo was usual care (0.59 [0.44–0.80], P = 0.0005), but not when placebo was non-fish oils; and (3) PUFA reduced POAF after CABG (0.68 [0.47–0.97], P = 0.03), but not other cardiac surgery.

Conclusions

PUFA appears to reduce the incidence of POAF. However, the said protective effect may be influenced by EPA/DHA ratio, with < 1 appearing preferable. PUFA efficacy on POAF prevention appeared insignificant when compared with non-fish oils and only apparent in the setting of CABG alone. Further studies are needed to confirm the effect of PUFA on POAF and to assess the proper use of PUFA against POAF.

PUFA, n-3 polyunsaturated fatty acids

POAF, postoperative atrial fibrillation

PUFA, n-3 polyunsaturated fatty acids

EPA, eicosapentaenoic acid

DHA, docosahexaenoic acid

PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses

PROSPERO, international prospective register of systematic reviews

E/D, EPA/DHA ratio

CABG, coronary-artery bypass grafting

CS, cardiac surgery

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Title: N-3 polyunsaturated fatty acids for prevention of postoperative atrial fibrillation: updated meta-analysis and systematic review
Authors: Hao Wang
Jindong Chen
Liang Zhao
Publication date: 01-03-2018
Publisher: Springer US
Published in: Journal of Interventional Cardiac Electrophysiology / Issue 2/2018
Print ISSN: 1383-875X
Electronic ISSN: 1572-8595
DOI: https://doi.org/10.1007/s10840-018-0315-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

N-3 polyunsaturated fatty acids for prevention of postoperative atrial fibrillation: updated meta-analysis and systematic review

Abstract

Background or purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background or purpose

Methods

Results

Conclusions

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