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ACC/AHA 2008 Performance Measures for Adults With ST-Elevation and Non-ST-Elevation Myocardial Infarction

ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease
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J Am Coll Cardiol, 2005; 45:1723-1728, doi:10.1016/j.jacc.2005.02.079
© 2005 by the American College of Cardiology Foundation
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EXPEDITED REVIEW

N-3 Fatty Acids for the Prevention of Atrial Fibrillation After Coronary Artery Bypass Surgery

A Randomized, Controlled Trial

Leonardo Calò, MD, FESC*, Leopoldo Bianconi, MD, Furio Colivicchi, MD, FESC, Filippo Lamberti, MD, Maria Luisa Loricchio, MD, Ermenegildo de Ruvo, MD, Antonella Meo, MD, Claudio Pandozi, MD, FESC, Mario Staibano, MD and Massimo Santini, MD, FESC, FACC

Department of Cardiac Diseases, San Filippo Neri Hospital, Rome, Italy

Manuscript received January 20, 2005; revised manuscript received February 18, 2005, accepted February 22, 2005.

* Reprint requests and correspondence: Dr. Leonardo Caló, Department of Cardiology, San Filippo Neri Hospital, Via della Pedica, 348, 00046 Grottaferrata, Rome, Italy (Email: leonardo.calo{at}tin.it).

OBJECTIVES: The aim of this study was to assess the efficacy of preoperative and postoperative treatment with n-3 polyunsaturated fatty acids (PUFAs) in preventing the occurrence of atrial fibrillation (AF) after coronary artery bypass graft surgery (CABG).

BACKGROUND: Postoperative AF is a common complication of CABG. There is growing clinical evidence that PUFAs have cardiac antiarrhythmic effects.

METHODS: A total of 160 patients were prospectively randomized to a control group (81 patients, 13 female, 64.9 ± 9.1 years) or PUFAs 2 g/day (79 patients, 11 female, 66.2 ± 8.0 years) for at least 5 days before elective CABG and until the day of discharge from the hospital. The primary end point was the development of AF in the postoperative period. The secondary end point was the hospital length of stay after surgery. All end points were independently adjudicated by two cardiologists blinded to treatment assignment.

RESULTS: The clinical and surgical characteristics of the patients in the two groups were similar. Postoperative AF developed in 27 patients of the control group (33.3%) and in 12 patients of the PUFA group (15.2%) (p = 0.013). There was no significant difference in the incidence of nonfatal postoperative complications, and postoperative mortality was similar in the PUFA-treated patients (1.3%) versus controls (2.5%). After CABG, the PUFA patients were hospitalized for significantly fewer days than controls (7.3 ± 2.1 days vs. 8.2 ± 2.6 days, p = 0.017).

CONCLUSIONS: This study first demonstrates that PUFA administration during hospitalization in patients undergoing CABG substantially reduced the incidence of postoperative AF (54.4%) and was associated with a shorter hospital stay.

Abbreviations and Acronyms
  AF = atrial fibrillation
  CABG = coronary artery bypass graft surgery
  CI = confidence interval
  DHA = docosahexaenoic acid
  EPA = eicosapentaenoic acid
  OR = odds ratio
  PUFA = n-3 polyunsaturated fatty acid




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