Department of Experimental and Applied Medicine, Section of Cardiovascular Diseases, University of Brescia Medical School, P. le Spedali Civili, 1-25123 Brescia, Italy.
Circulation. 2011 Sep 6;124(10):1100-6. doi: 10.1161/CIRCULATIONAHA.111.022194. Epub 2011 Aug 15.
n-3 polyunsaturated fatty acids (n-3 PUFAs) exert antiarrhythmic effects and reduce sudden cardiac death. However, their role in the prevention of atrial fibrillation remains controversial. We aimed to determine the effect of n-3 PUFAs in addition to amiodarone and a renin-angiotensin-aldosterone system inhibitor on the maintenance of sinus rhythm after direct current cardioversion in patients with persistent atrial fibrillation.
We conducted a randomized, double-blind, placebo-controlled, parallel-arm trial in patients with persistent atrial fibrillation, with at least 1 relapse after cardioversion, and treated with amiodarone and a renin-angiotensin-aldosterone system inhibitor. Participants were assigned to placebo or n-3 PUFAs 2 g/d and then underwent direct current cardioversion 4 weeks later. The primary end point was the probability of maintenance of sinus rhythm at 1 year after cardioversion. Of 254 screened patients, 199 were found to be eligible and randomized. At the 1-year follow up, the probability of maintenance of sinus rhythm was significantly higher in the n-3 PUFAs-treated patients compared with the placebo group (hazard ratio, 0.62 [95% confidence interval, 0.52 to 0.72] and 0.36 [95% confidence interval, 0.26 to 0.46], respectively; P=0.0001).
In patients with persistent atrial fibrillation on amiodarone and a renin-angiotensin-aldosterone system inhibitor, the addition of n-3 PUFAs 2 g/d improves the probability of the maintenance of sinus rhythm after direct current cardioversion. Our data suggest that n-3 PUFAs may exert beneficial effects in the prevention of atrial fibrillation recurrence. Further studies are needed to confirm and expand our findings. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT01198275.
n-3 多不饱和脂肪酸（n-3 PUFAs）具有抗心律失常作用，并可降低心源性猝死风险。然而，其在预防心房颤动方面的作用仍存在争议。我们旨在确定 n-3 PUFAs 联合胺碘酮和肾素-血管紧张素-醛固酮系统抑制剂在持续性心房颤动患者直流电复律后维持窦性心律的效果。
我们对至少 1 次复发性直流电复律后持续性心房颤动且正在接受胺碘酮和肾素-血管紧张素-醛固酮系统抑制剂治疗的患者进行了一项随机、双盲、安慰剂对照、平行分组试验。将参与者随机分配至安慰剂或 n-3 PUFAs 2 g/d 组，4 周后进行直流电复律。主要终点为复律后 1 年时维持窦性心律的概率。在 254 例筛选患者中，199 例符合入选标准并被随机分组。在 1 年随访时，n-3 PUFAs 治疗组维持窦性心律的概率显著高于安慰剂组（风险比，0.62 [95%置信区间，0.52 至 0.72] 和 0.36 [95%置信区间，0.26 至 0.46]；P=0.0001）。
在持续性心房颤动且正在接受胺碘酮和肾素-血管紧张素-醛固酮系统抑制剂治疗的患者中，每天加用 2 g n-3 PUFAs 可提高直流电复律后维持窦性心律的概率。我们的数据表明，n-3 PUFAs 可能对预防心房颤动复发具有有益作用。需要进一步的研究来证实和扩展我们的发现。临床试验注册- 网址：http://www.clinicaltrials.gov。唯一标识符：NCT01198275。
