n-3 PUFAs benefit atrial fibrillation patients on anti-arrhythmic therapy
MedWire News: Treatment with n-3 polyunsaturated fatty acids (PUFAs) may have beneficial effects in patients with persistent atrial fibrillation (AF), research suggests.
The team shows that treatment with 2 g per day of n-3 PUFAs, in addition to amiodarone and angiotensin-converting enzyme inhibitors (ACE-Is) or angiotensin II receptor blockers (ARBs), is significantly more effective in maintaining sinus rhythm after direct current cardioversion (DCCV) than therapy with amiodarone and ACE-Is or ARBs alone.
In addition, treatment with n-3 PUFAs appears to increase the length of time to first recurrence, note the authors.
"AF is the most common sustained arrhythmia and represents a growing burden on the healthcare system," explain Livio Dei Cas and colleagues, from the University of Brescia Medical School in Italy.
"Although rhythm control and rate control strategies seem to provide comparable results, restoration and maintenance of sinus rhythm would be the preferable pathophysiological approach," they say.
However, "current pharmacological antiarrhythmic therapies have limited efficacy and poor safety profiles, and invasive or surgical treatments are indicated only in a minority of patients and are not free of failure and procedural risks."
In the present study, Dei Cas's team tested the efficacy of n-3 PUFAs in the prevention of AF recurrences in 199 patients with persistent AF who were receiving amiodarone and a renin-angiotensin inhibitor (ACE-Is or ARBs).
Participants were randomly assigned to receive 2 g per day of n-3 PUFAs (n=57) or placebo (n=55). At least 4 weeks later they all underwent DCCV. The primary end point was the probability of maintenance of sinus rhythm at the 1-year follow-up.
As reported in the journal Circulation, the likelihood of maintenance of sinus rhythm was significantly higher in the n-3 PUFA group than the placebo group, at 62% versus 36%. Even after exclusion of patients with failed DCCV per protocol analysis, this pattern remained significant, at 64% versus 40%.
In addition, more patients in the placebo group experienced recurrence than in the n-3 group, at 56 versus 37. n-3 PUFAs also appeared to increase the mean time between DCCV and documented first recurrence, at 139 versus 168 days.
The researchers conclude that further studies are needed to determine whether treatment with n-3 PUFAs may prevent AF recurrence independently of anti-arrhythmic therapy.
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By Nikki Withers