• Umberto Benedetto, Emiliano Angeloni, Giovanni Melina, Tommaso H Danesi, Roberta Di Bartolomeo, Andrea Lechiancole, Simone Refice, Antonino Roscitano, Cosimo Comito, and Riccardo Sinatra.
• Department of Cardiac Surgery, School of Medicine, University of Rome La Sapienza, Via di Grottarossa 1039, Rome, Italy. u2benedetto@libero.it
• J Cardiovasc Med (Hagerstown). 2013 Feb 1;14(2):104-9.

Backgroundn-3 Polyunsaturated fatty acids (n-3 PUFAs) have been proposed as prophylactic therapy in the prevention of postoperative atrial fibrillation (POAF) in patients undergoing cardiac surgery. We conducted a meta-analysis of randomized controlled trials to better clarify this issue.MethodsAn electronic database search for randomized controlled trials on the effect of n-3 PUFAS on POAF was conducted, limited to English language publications until December 2010. For each study, data regarding the incidence of POAF were used to generate risk ratio (<1, favors n-3 PUFA; >1, favors placebo). Pooled summary effect estimate was calculated by means of a fixed or random effect according to heterogeneity. Meta-regression was used to investigate the effect of eicosapentaenoic acid (EPA)/docosahexaenoic acid (DHA) ratio and preoperative β-blockers on the effect of n-3 PUFA on POAF.ResultsThree publications were included in the analysis, enrolling a total of 431 patients. Overall incidence of POAF ranged from 24 to 54%. Pooling data, n-3 PUFA did not show a significant effect on the risk of POAF [risk ratio 0.89; 95% confidence interval (CI) 0.55-1.44; P=0.63]. However, meta-regression analysis showed a trend toward a benefit from n-3 PUFA supplementation when the EPA/DHA ratio was 1:2 (Q model=7.4; p model=0.02) and when preoperative β-blocker rate was lower (Q model=8.0; p model=0.01).ConclusionIn conclusion, the results of the present meta-analysis of randomized controlled trials suggest that preoperative n-3 PUFA therapy may not reduce POAF in patients undergoing cardiac surgery. However, several aspects may have influenced this negative result, which need to be investigated.

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