Supplementation with n-3 polyunsaturated fatty acids plus vitamins C and E reduced post-operative atrial fibrillation compared to placebo (9.7% vs 32.0%; p<0.001).
RCT (n=203)
randomized
Does supplementation with n-3 polyunsaturated fatty acids, vitamin C, and vitamin E reduce the occurrence of post-operative atrial fibrillation in patients scheduled for on-pump cardiac surgery?
Supplementation with n-3 polyunsaturated fatty acids, vitamin C, and vitamin E significantly reduced the incidence of post-operative atrial fibrillation and attenuated oxidative stress in patients undergoing on-pump cardiac surgery.
Absolute Event Rate: 9.7% vs 32%
p-value: p=< 0.001
OBJECTIVES: This study was designed to assess whether the reinforcement of the antioxidant system, through n-3 fatty acids plus antioxidant vitamin supplementation, could reduce the incidence of post-operative atrial fibrillation. BACKGROUND: Therapy to prevent post-operative atrial fibrillation remains suboptimal. Although oxidative stress plays a key role in the pathogenesis of this arrhythmia, antioxidant reinforcement has produced controversial results. METHODS: A total of 203 patients scheduled for on-pump cardiac surgery were randomized to placebo or supplementation with n-3 polyunsaturated fatty acids (2 g/day) (eicosapentaenoic acid:docosahexaenoic acid ratio 1:2), vitamin C (1 g/day), and vitamin E (400 IU/day). The primary outcome was the occurrence of post-operative atrial fibrillation. Secondary outcomes were the biomarkers related to oxidative stress and inflammation. RESULTS: Post-operative atrial fibrillation occurred in 10 of 103 patients (9.7%) in the supplemented group versus 32 of 100 patients (32%) in the placebo group (p < 0.001). Early after surgery, placebo patients presented with increased levels of biomarkers of inflammation and oxidative stress, which were markedly attenuated by antioxidant supplementation. The activity of catalase, superoxide dismutase, and glutathione peroxidase in atrial tissue of the supplemented patients was 24.0%, 17.1%, and 19.7% higher than the respective placebo values (p < 0.05). The atrial tissue of patients who developed atrial fibrillation showed NADPH oxidase p47-phox subunit protein and mRNA expression 38.4% and 35.7% higher, respectively, than patients in sinus rhythm (p < 0.05). CONCLUSIONS: This safe, well-tolerated, and low-cost regimen, consisting of n-3 polyunsaturated fatty acids plus vitamins C and E supplementation, favorably affected post-operative atrial fibrillation, increased antioxidant potential, and attenuated oxidative stress and inflammation. (Prevention of Post-Operative Atrial Fibrillation: Pathophysiological Characterization of a Pharmacological Intervention Based on a Novel Model of Nonhypoxic Pre-Conditioning; ISRCTN45347268).
Rodrigo et al. (2013) conducted an RCT in Post-operative atrial fibrillation (n=203). n-3 polyunsaturated fatty acids plus vitamins C and E vs. Placebo was evaluated on Occurrence of post-operative atrial fibrillation (p=< 0.001). Supplementation with n-3 polyunsaturated fatty acids plus vitamins C and E reduced post-operative atrial fibrillation compared to placebo (9.7% vs 32.0%; p<0.001).