The Role of Fish Oil in Arrhythmia Prevention

Abstract

Numerous epidemiological studies, case-control series, and randomized trials have demonstrated the ability of fish oil to reduce major cardiovascular events, particularly sudden cardiac death and all-cause mortality. We discuss the potential benefits of fish oil therapy to improve overall autonomic tone and potentially reduce the risk of major ventricular and atrial arrhythmias. Specifically, this review focuses on how fish oil therapy has performed in 3 primary prevention trials in patients with implantable cardioverter defibrillators, reviews the effects that fish oil has on the autonomic nervous system, focuses on the use of fish oil as a novel therapy for atrial fibrillation, and revisits other beneficial properties of fish oil (ie, ability to lower serum triglycerides, anti-inflammatory effects, and possible improvements in arterial pressure/diastolic function). We also discuss the safety profile of fish oil, including effects on bleeding time and bleeding complications as well as provide commentary regarding fish oil supplementation in light of increasing contaminants contained in fish. In summary, any patient with documented coronary heart disease and those with risk factors for sudden cardiac death, such as left ventricular dysfunction, left ventricular hypertrophy, prior myocardial infarction, or high-grade ventricular dysrhythmias, should consider fish oil supplementation. The American Heart Association recommends four 3-ounce servings of oily fish weekly. For those who cannot eat fish or do not have access to fish, as well as those who would prefer not to eat fish regularly, capsules of fish oil are readily available in various concentrations. At the present time, we recommend doses of eicosapentanoic acid and docosahexanoic acid in the combined range of 800 to 1000 mg/day for primary and secondary prevention of cardiovascular disease.

Serum Long-Chain n-3 Polyunsaturated Fatty Acids and Risk of Hospital Diagnosis of Atrial Fibrillation in Men

“…4 However, previous studies have been inconsistent with regard to the impact of fish or fish oils on cardiac arrhythmias. 5 In a prospective cohort study, 6 consumption of baked or broiled fish was associated with a lower incidence of AF, and in a randomized trial, fish oil supplementation prevented occurrence of AF after coronary artery bypass grafting. 7 However, conflicting results were observed in 3 other prospective studies.…”

Uses and benefits of omega-3 ethyl esters in patients with cardiovascular disease

“…74,75 Finally, omega-3 EEs may reduce arrhythmic events modulating autonomic tone. 25,76 This hypothesis seems to be corroborated by some studies on heart rate variability (HRV), a risk marker for sudden cardiac death. Omega-3 fatty acids content of cell membranes was positively correlated with HRV, 77 and oral supplementation with 5200 mg/day of omega-3 fatty acids for three months in patients with recent MI significantly increased HRV.…”

Omega-3 Fatty Acids and Primary and Secondary Prevention of Cardiovascular Disease

“…Anand et al also suggest that any patient with documented CHD and those with risk factors for SCD, such as LV dysfunction, LV hypertrophy, prior MI or high-grade ventricular dysrhythmias, should consider fish oil supplementation [26].…”