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Prescription omega-3 fatty acids do not reduce risk of recurrent A fib

Clinical Question:
Can supplementation with prescription omega-3 fatty acids reduce the risk of recurrent atrial fibrillation?

Bottom Line:
Supplementation with prescription omega-3 fatty acids does not reduce the risk of recurrent symptomatic atrial fibrillation (AF). (LOE = 1b)

Reference:
Kowey PR, Reiffel JA, Ellenbogen KA, Naccarelli GV, Pratt CM. Efficacy and safety of prescription omega-3 fatty acids for the prevention of recurrent symptomatic atrial fibrillation. A randomized controlled trial. JAMA 2010;304(21):2363-2372.  [PMID:21078810]

Study Design:
Randomized controlled trial (double-blinded)

Funding:
Industry

Allocation:
Concealed

Setting:
Outpatient (specialty)

Synopsis:
To evaluate the efficacy of fish oil supplementation to prevent recurrent AF these investigators identified 663 adults, 18 years or older, with confirmed symptomatic paroxysmal or successfully treated persistent AF and normal sinus rhythm at baseline. Exclusion criteria included secondary AF due to hypothyroidism or structural heart disease, current antiarrhythmic therapy, use of amiodarone within 6 months, or prior ablation therapy. Patients randomly received (concealed allocation assignment) a loading dose of 8 g per day of prescription omega-3 fatty acids for 7 days followed by 4 g per day, or matched placebo containing corn oil. Individuals masked to treatment group assignment assessed outcomes biweekly using transtelephonic heart monitoring. Complete follow-up occurred for 88% of participants at 6 months. Using modified intention-to-treat analysis (including patients with at least 1 postrandomization heart monitor episode), a similar percentage of individuals in the omega-3 and placebo groups experienced an episode of recurrent symptomatic AF (52% vs 48%, respectively). Omega-3 fatty acid levels were significantly higher in the treatment group. Drop-outs due to adverse events occurred similarly in both groups (approximately 5%). The study was 80% powered to detect a clinically significant difference between the 2 groups.

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