Omega-3 Polyunsaturated Fatty Acids and Ventricular Arrhythmias in Patients with Implanted Cardioverter-Defibrillator: Systematic Review with Meta-analysis

Abstract

Background: Omega-3 polyunsaturated fatty acids (PUFA) are one of the most common supplements taken around the world, due to many beliefs in its positive effect on cardiovascular disease and cardiovascular related death. Nevertheless, despite showing promising results on in vitro and in vivo animal studies, PUFA’s cardiovascular and, more specifically, antiarrhythmic role is still not well established in humans. Patients with implanted cardioverter-defibrillator (ICD) are a subset of individuals at a greater risk of suffering deadly arrythmias, which have a device that can detect, register and intervene in those arrhythmias. We aimed to understand the antiarrhythmic influence of omega-3 PUFA in patients with ICD.

Methods: In this systematic review we searched randomized controlled trials regarding the arrhythmic effects of omega-3 PUFA supplementation on ICD patients, comparing to either placebo or no intervention at all. Results were pooled using a random effects model and reported using Hazard ratio (HR) with a 95% confidence interval (CI).

Results: Of the 5 retrieved studies for review, 4 (n=1714) were included in the meta-analysis. Compared to placebo, there was not a significant risk reduction of ventricular arrhythmia or death (HR =0.88, 95% CI 0.71-1.10). The presence or absence of coronary disease as well as the severity of left ventricular systolic dysfunction did not influence the results. However, when excluding the first published study (n=200), a significant risk reduction of ventricular arrhythmias or death was observed with n-3 PUFA on ICD patients (HR 0.80, 95% CI 0.67-0.96; p= 0.014).

Conclusion: The best available evidence does not support the recommendation of using omega-3 PUFA on ICD patients to reduce death or significant arrhythmias.