Summary
Conclusions
The efficacy of n-3 PUFA in preventing AF has been tested, with conflicting results, in several randomised clinical trials conducted both in patients with a history of AF and in those undergoing cardiac surgery (the so-called POAF). The results of these trials do not support the routine use of n-3 PUFA in AF prevention in both settings. Accordingly, both European51 and US guidelines52 do not recommend their systematic use in clinical practice. The promising results of the combination of n-3 PUFA with other drugs with antioxidant proprieties need to be confirmed, providing interesting pathophysiological explanation of the conflicting results of the studies by pointing out the importance of oxidative stress over inflammation in the pathogenesis of AF and particularly of POAF.
Clinical Perspective
- Atrial fibrillation (AF) is associated with an increased risk of fatal and nonfatal events and current antiarrhythmic drugs provide limited protection against AF recurrence and have poor safety profile.
- Understanding of the pathophysiological mechanisms that underlie AF has led to the development of upstream strategies for AF prevention.
- n-3 polyunsaturated fatty acids (n-3 PUFA) are safe, well tolerated and have multiple effects on cardiac electrophysiology and both clinical and preclinical studies have shown ‘antiarrhythmic properties’.
- The efficacy of n-3 PUFA in preventing AF has been tested, with conflicting results, in several randomised clinical trials conducted both in patients with history of AF and in those undergoing cardiac surgery (so-called post-operative AF).
- The results of these trials do not support the routine use of n-3 PUFA in AF prevention, but their combination with other drugs with antioxidant proprieties seem to have promising perspectives
