European Heart Journal Advance Access originally published online on February 4, 2009
European Heart Journal 2009 30(7):820-826; doi:10.1093/eurheartj/ehp003
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Effect of fish oil on ventricular tachyarrhythmia in three studies in patients with implantable cardioverter defibrillators
1 TI Food and Nutrition, Wageningen, The Netherlands
2 Institute of Health Sciences, VU University Amsterdam, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands
3 Portland Veterans Administration Medical Center, Portland, OR, USA
4 Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
5 Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Sciences University, Portland, OR, USA
6 Department of Public Health and Preventive Medicine, Oregon Health and Sciences University, Portland, OR, USA
7 Department of Pharmacy Practice, Oregon State University, Portland, OR, USA
8 Unilever Food and Health Research Institute, Vlaardingen, The Netherlands
9 Division of Endocrinology, Metabolism, and Clinical Nutrition, Department of Medicine, Oregon Health and Science University, Portland, OR, USA
10 St George Hospital and Medical School, London, UK
11 Good Samaritan Hospital, Portland, OR, USA
Received 25 March 2008; revised 16 December 2008; accepted 24 December 2008; online publish-ahead-of-print 4 February 2009.
* Corresponding author. Tel: +31 20 5987702, Fax: +31 20 5986940, Email: ingeborg.brouwer{at}falw.vu.nl
Aims: To determine the effects of omega-3 polyunsaturated fatty acids (omega-3 PUFAs) from fish on the incidence of recurrent ventricular arrhythmia in implantable cardioverter defibrillator (ICD) patients by combining results from published trials.
Methods and results: We searched in the Medline, EMBASE, and Cochrane databases and performed a meta-analysis on all three available trials on fish oil and ventricular arrhythmia. Furthermore, we pooled individual data of two of these randomized, double-blind, placebo-controlled trials (Raitt et al. Fish oil supplementation and risk of ventricular tachycardia and ventricular fibrillation in patients with implantable defibrillators: a randomized controlled trial. JAMA 2005;293:2884–2891 and Brouwer et al. Effect of fish oil on ventricular tachyarrhythmia and death in patients with implantable cardioverter defibrillators: the Study on Omega-3 Fatty Acids and Ventricular Arrhythmia (SOFA) randomized trial. JAMA 2006;295:2613–2619). The main outcome was time to first confirmed ventricular fibrillation (VF) or ventricular tachycardia (VT) combined with death for the meta-analysis, and time to first spontaneous confirmed VF or VT for the pooled analysis. The meta-analysis (n = 1148) showed no convincing protective effect of fish oil (RR 0.90; 95% CI 0.67–1.22). The hazard ratio for the subgroup of patients with coronary artery disease at baseline (0.79; 0.60–1.06) tended towards a protective effect. The pooled analysis (n = 722) showed that time to appropriate ICD intervention was similar for fish oil and placebo treatment (log-rank P = 0.79).
Conclusion: These findings do not support a protective effect of omega-3 PUFAs from fish oil on cardiac arrhythmia in all patients with an ICD. Current data neither prove nor disprove a beneficial or a detrimental effect for subgroups of patients with specific underlying pathologies.
Key Words: ICD • Arrhythmia • Fish oil • Omega-3