Omega-3 fatty acid supplementation for the prevention of arrhythmias

  • Mina K. ChungEmail author

Opinion statement

Fish oil, or omega-3 (n-3) polyunsaturated fatty acid (PUFA), supplements have been purported to produce potential health benefits. One of the strongest supported effects of n-3 PUFAs may be their potential benefits in reducing the risk of sudden cardiac death. This article reviews clinical and mechanistic studies that may explain the effects of these agents on ischemic arrhythmias, sudden death, and atrial fibrillation.


Polyunsaturated Fatty Acid Sudden Death Sudden Cardiac Death PUFA Supplementation Rapid Atrial Pace 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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References and Recommended Reading

  1. 1.
    Lee KW, Lip GY: The role of omega-3 fatty acids in the secondary prevention of cardiovascular disease. QJM 2003, 96: 465–480.PubMedCrossRefGoogle Scholar
  2. 2.
    Leaf A, Kang JX, Xiao YF, Billman GE: Clinical prevention of sudden cardiac death by n-3 polyunsaturated fatty acids and mechanism of prevention of arrhythmias by n-3 fish oils. Circulation 2003, 107: 2646–2652.PubMedCrossRefGoogle Scholar
  3. 3.
    Jouven X, Charles MA, Desnos M, Ducimetiere P: Circulating nonesterified fatty acid level as a predictive risk factor for sudden death in the population. Circulation 2001, 104: 756–761.PubMedCrossRefGoogle Scholar
  4. 4.
    Siscovick DS, Raghunathan TE, King I, et al.: Dietary intake and cell membrane levels of long-chain n-3 polyunsaturated fatty acids and the risk of primary cardiac arrest. JAMA 1995, 274: 1363–1367.PubMedCrossRefGoogle Scholar
  5. 5.
    Albert CM, Campos H, Stampfer MJ, et al.: Blood levels of long-chain n-3 fatty acids and the risk of sudden death. N Engl J Med 2002, 346: 1113–1118.PubMedCrossRefGoogle Scholar
  6. 6.
    Burr ML, Fehily AM, Gilbert JF, et al.: Effects of changes in fat, fish, and fibre intakes on death and myocardial reinfarction: diet and reinfarction trial (DART). Lancet 1989, 2: 757–761.PubMedCrossRefGoogle Scholar
  7. 7.
    Marchioli R, Barzi F, Bomba E, et al.: Early protection against sudden death by n-3 polyunsaturated fatty acids after myocardial infarction: time-course analysis of the results of the Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto Miocardico (GISSI)-Prevenzione. Circulation 2002, 105: 1897–1903.PubMedCrossRefGoogle Scholar
  8. 8.
    Macchia A, Levantesi G, Franzosi MG, et al.: Left ventricular systolic dysfunction, total mortality, and sudden death in patients with myocardial infarction treated with n-3 polyunsaturated fatty acids. Eur J Heart Fail 2005, 7: 904–909.PubMedCrossRefGoogle Scholar
  9. 9.
    Albert CM, Hennekens CH, O’Donnell CJ, et al.: Fish consumption and risk of sudden cardiac death. JAMA 1998, 279: 23–28.PubMedCrossRefGoogle Scholar
  10. 10.
    Singh RB, Niaz MA, Sharma JP, et al.: Randomized, double-blind, placebo-controlled trial of fish oil and mustard oil in patients with suspected acute myocardial infarction: the Indian experiment of infarct survival-4. Cardiovasc Drugs Ther 1997, 11: 485–491.PubMedCrossRefGoogle Scholar
  11. 11.
    Yokoyama M, Origasa H, Matsuzaki M, et al.: Effects of eicosapentaenoic acid on major coronary events in hypercholesterolaemic patients (JELIS): a randomised open-label, blinded endpoint analysis. Lancet 2007, 369: 1090–1098.PubMedCrossRefGoogle Scholar
  12. 12.
    Schrepf R, Limmert T, Claus Weber P, et al.: Immediate effects of n-3 fatty acid infusion on the induction of sustained ventricular tachycardia. Lancet 2004, 363: 1441–1442.PubMedCrossRefGoogle Scholar
  13. 13.
    Raitt MH, Connor WE, Morris C, 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.PubMedCrossRefGoogle Scholar
  14. 14.
    Leaf A, Albert CM, Josephson M, et al.: Prevention of fatal arrhythmias in high-risk subjects by fish oil n-3 fatty acid intake. Circulation 2005, 112: 2762–2768.PubMedCrossRefGoogle Scholar
  15. 15.
    Brouwer IA, Zock PL, Camm AJ, 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.PubMedCrossRefGoogle Scholar
  16. 16.
    Bucher HC, Hengstler P, Schindler C, Meier G: N-3 polyunsaturated fatty acids in coronary heart disease: a meta-analysis of randomized controlled trials. Am J Med 2002, 112: 298–304.PubMedCrossRefGoogle Scholar
  17. 17.
    Hooper L, Thompson RL, Harrison RA, et al.: Risks and benefits of omega 3 fats for mortality, cardiovascular disease, and cancer: systematic review. BMJ 2006, 332: 752–760.PubMedCrossRefGoogle Scholar
  18. 18.
    McLennan PL, Abeywardena MY, Charnock JS: Dietary fish oil prevents ventricular fibrillation following coronary artery occlusion and reperfusion. Am Heart J 1988, 116: 709–717.PubMedCrossRefGoogle Scholar
  19. 19.
    McLennan PL, Abeywardena MY, Charnock JS. Reversal of the arrhythmogenic effects of long-term saturated fatty acid intake by dietary n-3 and n-6 polyunsaturated fatty acids. Am J Clin Nutr 1990, 51: 53–58.PubMedGoogle Scholar
  20. 20.
    McLennan PL, Bridle TM, Abeywardena MY, Charnock JS: Dietary lipid modulation of ventricular fibrillation threshold in the marmoset monkey. Am Heart J 1992, 123: 1555–1561.PubMedCrossRefGoogle Scholar
  21. 21.
    Billman GE, Hallaq H, Leaf A: Prevention of ischemia-induced ventricular fibrillation by omega 3 fatty acids. Proc Natl Acad Sci U S A 1994, 91: 4427–4430.PubMedCrossRefGoogle Scholar
  22. 22.
    Billman GE, Kang JX, Leaf A: Prevention of ischemia-induced cardiac sudden death by n-3 polyunsaturated fatty acids in dogs. Lipids 1997, 32: 1161–1168.PubMedCrossRefGoogle Scholar
  23. 23.
    Billman GE, Kang JX, Leaf A: Prevention of sudden cardiac death by dietary pure omega-3 polyunsaturated fatty acids in dogs. Circulation 1999, 99: 2452–2457.PubMedGoogle Scholar
  24. 24.
    Jones PJ, Lau VW: Effect of n-3 polyunsaturated fatty acids on risk reduction of sudden death. Nutr Rev 2002, 60: 407–409.PubMedCrossRefGoogle Scholar
  25. 25.
    Pepe S, McLennan PL: Cardiac membrane fatty acid composition modulates myocardial oxygen consumption and postischemic recovery of contractile function. Circulation 2002, 105: 2303–2308.PubMedCrossRefGoogle Scholar
  26. 26.
    Sethi S, Ziouzenkova O, Ni H, et al.: Oxidized omega-3 fatty acids in fish oil inhibit leukocyte-endothelial interactions through activation of PPAR alpha. Blood 2002, 100: 1340–1346.PubMedCrossRefGoogle Scholar
  27. 27.
    Holub BJ: Clinical nutrition: 4. Omega-3 fatty acids in cardiovascular care. CMAJ 2002, 166: 608–615.PubMedGoogle Scholar
  28. 28.
    Calabresi L, Villa B, Canavesi M, et al.: An omega-3 polyunsaturated fatty acid concentrate increases plasma high-density lipoprotein 2 cholesterol and paraoxonase levels in patients with familial combined hyperlipidemia. Metabolism 2004, 53: 153–158.PubMedCrossRefGoogle Scholar
  29. 29.
    Thies F, Garry JM, Yaqoob P, et al.: Association of n-3 polyunsaturated fatty acids with stability of atherosclerotic plaques: a randomised controlled trial. Lancet 2003, 361: 477–485.PubMedCrossRefGoogle Scholar
  30. 30.
    Calo L, Bianconi L, Colivicchi F, et al.: N-3 Fatty acids for the prevention of atrial fibrillation after coronary artery bypass surgery: a randomized, controlled trial. J Am Coll Cardiol 2005, 45: 1723–1728.PubMedCrossRefGoogle Scholar
  31. 31.
    Mozaffarian D, Psaty BM, Rimm EB, et al.: Fish intake and risk of incident atrial fibrillation. Circulation 2004, 110: 368–373.PubMedCrossRefGoogle Scholar
  32. 32.
    Frost L, Vestergaard P: n-3 Fatty acids consumed from fish and risk of atrial fibrillation or flutter: the Danish Diet, Cancer, and Health Study. Am J Clin Nutr 2005, 81: 50–54.PubMedGoogle Scholar
  33. 33.
    Brouwer IA, Heeringa J, Geleijnse JM, et al.: Intake of very long-chain n-3 fatty acids from fish and incidence of atrial fibrillation. The Rotterdam Study. Am Heart J 2006, 151: 857–862.PubMedCrossRefGoogle Scholar
  34. 34.
    Sarrazin JF, Comeau G, Daleau P, et al.: Reduced incidence of vagally induced atrial fibrillation and expression levels of connexins by n-3 polyunsaturated fatty acids in dogs. J Am Coll Cardiol 2007, 50: 1505–1512.PubMedCrossRefGoogle Scholar
  35. 35.
    Ninio DM, Murphy KJ, Howe PR, Saint DA: Dietary fish oil protects against stretch-induced vulnerability to atrial fibrillation in a rabbit model. J Cardiovasc Electrophysiol 2005, 16: 1189–1194.PubMedCrossRefGoogle Scholar
  36. 36.
    Sakabe M, Shiroshita-Takeshita A, Maguy A, et al.: Omega-3 polyunsaturated fatty acids prevent atrial fibrillation associated with heart failure but not atrial tachycardia remodeling. Circulation 2007, 116: 2101–2109.PubMedCrossRefGoogle Scholar
  37. 37.
    da Cunha DN, Hamlin RL, Billman GE, Carnes CA: n-3 (omega-3) polyunsaturated fatty acids prevent acute atrial electrophysiological remodeling. Br J Pharmacol 2007, 150: 281–285.PubMedCrossRefGoogle Scholar
  38. 38.
    Geelen A, Brouwer IA, Schouten EG, et al.: Effects of n-3 fatty acids from fish on premature ventricular complexes and heart rate in humans. Am J Clin Nutr 2005, 81: 416–420.PubMedGoogle Scholar
  39. 39.
    Covington MB: Omega-3 fatty acids. Am Fam Physician 2004, 70: 133–140.PubMedGoogle Scholar
  40. 40.
    Davis BC, Kris-Etherton PM: Achieving optimal essential fatty acid status in vegetarians: current knowledge and practical implications. Am J Clin Nutr 2003, 78(3 Suppl): 640S–646S.PubMedGoogle Scholar
  41. 41.
    Sidhu KS: Health benefits and potential risks related to consumption of fish or fish oil. Regul Toxicol Pharmacol 2003, 38: 336–344.PubMedCrossRefGoogle Scholar
  42. 42.
    Kris-Etherton PM, Harris WS, Appel LJ: Fish consumption, fish oil, omega-3 fatty acids, and cardiovascular disease. Circulation 2002, 106: 2747–2757.PubMedCrossRefGoogle Scholar
  43. 43.
    Kris-Etherton PM, Harris WS, Appel LJ: Omega-3 fatty acids and cardiovascular disease: new recommendations from the American Heart Association. Arterioscler Thromb Vasc Biol 2003, 23: 151–152.PubMedCrossRefGoogle Scholar
  44. 44.
    Vogel JH, Bolling SF, Costello RB, et al.: Integrating complementary medicine into cardiovascular medicine. A report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents (Writing Committee to Develop an Expert Consensus Document on Complementary and Integrative Medicine). J Am Coll Cardiol 2005, 46: 184–221.PubMedCrossRefGoogle Scholar
  45. 45.
    US Environmental Protection Agency: Fish advisory: what you need to know about mercury in fish and shellfish. Available at Accessed July 2008.
  46. 46.
    US Department of Agriculture: National Nutrient Database for Standard Reference, Release 20. Available at Accessed April 13, 2008.

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  1. 1.Department of Cardiovascular MedicineCleveland ClinicClevelandUSA

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