Skip to main content

Advertisement

SpringerLink
Log in

Effect of supplemented intake of omega-3 fatty acids on arrhythmias in patients with ICD: fish oil therapy may reduce ventricular arrhythmia

  • Published:
Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Purpose

The aim of this study was to evaluate the effects of fish oils, including eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), on ventricular tachyarrhythmic episodes (VTEs) in implantable cardioverter defibrillator (ICD) recipients with ischemic cardiomyopathy.

Methods

One hundred five ICD recipients with ischemic cardiomyopathy received 3.6 g of EPA and DHA and placebo for 6 months, each at a random order, with a 4-month washout period between treatments. Eighty-seven patients completed the 16-month study protocol. The primary end point was any VTE (including sustained and non-sustained ventricular tachycardias at a rate of >150 bpm) as recorded by the ICDs. Secondary end points included device therapy (anti-tachycardia pacing (ATP) or shocks).

Results

During treatment with fish oils, there was a significant increase in EPA and DHA concentrations in red blood cells (RBCs) and subcutaneous fat tissue. Among 87 patients who completed the study protocol, the mean number of VTEs was significantly lower during treatment with fish oil (1.7) vs. placebo (5.6; p = 0.035). Appropriate device therapy for VTE occurred in 18 (21%) patients. Fish oil therapy was associated with a trend toward fewer VTEs terminated with ATP (2.8 ± 13.7 vs. 0.5 ± 2.1, respectively; p = 0.077). VTE terminated by ICD shocks, however, was rare, and rates were similar between both groups (0.11 ± 0.6 vs. 0.10 ± 0.4, p = not significant, respectively).

Conclusions

Our data suggest that fish oil therapy may be associated with a reduction in the frequency of VTE in ICD recipients with ischemic cardiomyopathy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Albert CM, Hennekens CH, O’Donnell CJ, Ajani UA, Carey VJ, Willett WC, et al. Fish consumption and risk of sudden cardiac death. JAMA. 1998;279(1):23–8.

    Article  CAS  PubMed  Google Scholar 

  2. Albert CM, Campos H, Stampfer MJ, Ridker PM, Manson JE, Willett WC, et al. Blood levels of long-chain n-3 fatty acids and the risk of sudden death. N Engl J Med. 2002;346(15):1113–8.

    Article  CAS  PubMed  Google Scholar 

  3. Siscovick DS, Raghunathan TE, King I, Weinmann S, Wicklund KG, Albright J, 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(17):1363–7.

    Article  CAS  PubMed  Google Scholar 

  4. Lemaitre RN, King IB, Mozaffarian D, Kuller LH, Tracy RP, Siscovick DS. n-3 Polyunsaturated fatty acids, fatal ischemic heart disease, and nonfatal myocardial infarction in older adults: the Cardiovascular Health Study. Am J Clin Nutr. 2003;77(2):319–25.

    CAS  PubMed  Google Scholar 

  5. Burr ML, Fehily AM, Gilbert JF, Rogers S, Holliday RM, Sweetnam PM, et al. Effects of changes in fat, fish, and fibre intakes on death and myocardial reinfarction: diet and reinfarction trial (DART). Lancet. 1989;2(8666):757–61.

    Article  CAS  PubMed  Google Scholar 

  6. Marchioli R, Barzi F, Bomba E, Chieffo C, Di Gregorio D, Di Mascio R, 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(16):1897–903.

    Article  CAS  PubMed  Google Scholar 

  7. Goodfellow J, Bellamy MF, Ramsey MW, Jones CJ, Lewis MJ. Dietary supplementation with marine omega-3 fatty acids improve systemic large artery endothelial function in subjects with hypercholesterolemia. J Am Coll Cardiol. 2000;35(2):265–70.

    Article  CAS  PubMed  Google Scholar 

  8. Nestel P. Fish oil fatty acids beneficially modulate vascular function. World Rev Nutr Diet. 2001;88:86–9.

    Article  CAS  PubMed  Google Scholar 

  9. Weber P, Raederstorff D. Triglyceride-lowering effect of omega-3 LC-polyunsaturated fatty acids—a review. Nutr Metab Cardiovasc Dis. 2000;10(1):28–37.

    CAS  PubMed  Google Scholar 

  10. Miller M. Current perspectives on the management of hypertriglyceridemia. Am Heart J. 2000;140(2):232–40.

    Article  CAS  PubMed  Google Scholar 

  11. Nilsen DW, Albrektsen G, Landmark K, Moen S, Aarsland T, Woie L. Effects of a high-dose concentrate of n-3 fatty acids or corn oil introduced early after an acute myocardial infarction on serum triacylglycerol and HDL cholesterol. Am J Clin Nutr. 2001;74(1):50–6.

    CAS  PubMed  Google Scholar 

  12. Calder PC. Omega 3 polyunsaturated fatty acids, inflammation and immunity. World Rev Nutr Diet. 2001;88:109–16.

    Article  CAS  PubMed  Google Scholar 

  13. Blok WL, Katan MB, van der Meer JW. Modulation of inflammation and cytokine production by dietary (n-3) fatty acids. J Nutr. 1996;126(6):1515–33.

    CAS  PubMed  Google Scholar 

  14. James MJ, Gibson RA, Cleland LG. Dietary polyunsaturated fatty acids and inflammatory mediator production. Am J Clin Nutr. 2000;71(1 Suppl):343S–8S.

    CAS  PubMed  Google Scholar 

  15. Geleijnse JM, Giltay EJ, Grobbee DE, Donders AR, Kok FJ. Blood pressure response to fish oil supplementation: metaregression analysis of randomized trials. J Hypertens. 2002;20(8):1493–9.

    Article  CAS  PubMed  Google Scholar 

  16. Knapp HR. Dietary fatty acids in human thrombosis and hemostasis. Am J Clin Nutr. 1997;65(5 Suppl):1687S–98S.

    CAS  PubMed  Google Scholar 

  17. Hornstra G. Influence of dietary fat type on arterial thrombosis tendency. J Nutr Health Aging. 2001;5(3):160–6.

    CAS  PubMed  Google Scholar 

  18. Thies F, Garry JM, Yaqoob P, Rerkasem K, Williams J, Shearman CP, et al. Association of n-3 polyunsaturated fatty acids with stability of atherosclerotic plaques: a randomised controlled trial. Lancet. 2003;361(9356):477–85.

    Article  CAS  PubMed  Google Scholar 

  19. Mori TA, Beilin LJ. Long-chain omega 3 fatty acids, blood lipids and cardiovascular risk reduction. Curr Opin Lipidol. 2001;12(1):11–7.

    Article  CAS  PubMed  Google Scholar 

  20. Leaf A, Xiao YF. The modulation of ionic currents in excitable tissues by n-3 polyunsaturated fatty acids. J Membr Biol. 2001;184(3):263–71.

    Article  CAS  PubMed  Google Scholar 

  21. 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(21):2646–52.

    Article  PubMed  Google Scholar 

  22. Den Ruijter HM, Verkerk AO, Berecki G, Bakker D, van Ginneken AC, Coronel R. Dietary fish oil reduces the occurrence of early after depolarizations in pig ventricular myocytes. J Mol Cell Cardiol. 2006;

  23. Berecki G, Den Ruijter HM, Verkerk AO, Schumacher CA, Baartscheer A, Bakker D, et al. Dietary fish oil reduces the incidence of triggered arrhythmias in pig ventricular myocytes. Heart Rhythm. 2007;4(11):1452–60.

    Article  PubMed  Google Scholar 

  24. Kang JX, Leaf A. The cardiac antiarrhythmic effects of polyunsaturated fatty acid. Lipids. 1996;31(Suppl):S41–4.

    Article  CAS  PubMed  Google Scholar 

  25. Kang JX, Leaf A. Prevention of fatal cardiac arrhythmias by polyunsaturated fatty acids. Am J Clin Nutr. 2000;71(1 Suppl):202S–7S.

    CAS  PubMed  Google Scholar 

  26. Brouwer IA, Zock PL, Camm AJ, Bocker D, Hauer RN, Wever EF, 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(22):2613–9.

    Article  CAS  PubMed  Google Scholar 

  27. Raitt MH, Connor WE, Morris C, Kron J, Halperin B, Chugh SS, 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(23):2884–91.

    Article  CAS  PubMed  Google Scholar 

  28. Leaf A, Albert CM, Josephson M, Steinhaus D, Kluger J, Kang JX, et al. Prevention of fatal arrhythmias in high-risk subjects by fish oil n-3 fatty acid intake. Circulation. 2005;112(18):2762–8.

    Article  CAS  PubMed  Google Scholar 

  29. Handelman GJ, Epstein WL, Machlin LJ, van Kuijk FJ, Dratz EA. Biopsy method for human adipose with vitamin E and lipid measurements. Lipids. 1988;23(6):598–604.

    Article  CAS  PubMed  Google Scholar 

  30. Friedman PA, McClelland RL, Bamlet WR, Acosta H, Kessler D, Munger TM, et al. Dual-chamber versus single-chamber detection enhancements for implantable defibrillator rhythm diagnosis: the detect supraventricular tachycardia study. Circulation. 2006;113(25):2871–9.

    Article  PubMed  Google Scholar 

  31. Carney RM, Freedland KE, Rubin EH, Rich MW, Steinmeyer BC, Harris WS. Omega-3 augmentation of sertraline in treatment of depression in patients with coronary heart disease: a randomized controlled trial. JAMA. 2009;302(15):1651–7. doi:10.1001/jama.2009.1487.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Metcalf RG, James MJ, Gibson RA, Edwards JR, Stubberfield J, Stuklis R, et al. Effects of fish-oil supplementation on myocardial fatty acids in humans. Am J Clin Nutr. 2007;85(5):1222–8.

    CAS  PubMed  Google Scholar 

  33. Marchioli R, Valagussa F. The results of the GISSI-Prevenzione trial in the general framework of secondary prevention. Eur Heart J. 2000;21(12):949–52.

    Article  CAS  PubMed  Google Scholar 

  34. Dietary supplementation with n-3 polyunsaturated fatty acids and vitamin E after myocardial infarction: results of the GISSI-Prevenzione trial. Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto miocardico. Lancet. 1999;354(9177):447–55.

  35. Brouwer IA, Raitt MH, Dullemeijer C, Kraemer DF, Zock PL, Morris C, et al. Effect of fish oil on ventricular tachyarrhythmia in three studies in patients with implantable cardioverter defibrillators. Eur Heart J. 2009;30(7):820–6. doi:10.1093/eurheartj/ehp003.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Cheema AN, Sheu K, Parker M, Kadish AH, Goldberger JJ. Nonsustained ventricular tachycardia in the setting of acute myocardial infarction: tachycardia characteristics and their prognostic implications. Circulation. 1998;98(19):2030–6.

    Article  CAS  PubMed  Google Scholar 

  37. Doval HC, Nul DR, Grancelli HO, Varini SD, Soifer S, Corrado G, et al. Nonsustained ventricular tachycardia in severe heart failure. Independent marker of increased mortality due to sudden death. GESICA-GEMA Investigators. Circulation. 1996;94(12):3198–203.

    Article  CAS  PubMed  Google Scholar 

  38. Pires LA, Lehmann MH, Buxton AE, Hafley GE, Lee KL, Tachycardia MU. Trial I. Differences in inducibility and prognosis of in-hospital versus out-of-hospital identified nonsustained ventricular tachycardia in patients with coronary artery disease: clinical and trial design implications. J Am Coll Cardiol. 2001;38(4):1156–62.

    Article  CAS  PubMed  Google Scholar 

  39. Hans J. Moore M, Ross D. Fletcher, MD, Mason D. Platt, BS, Robin Boineau, MD, Jill Anderson, RN, BSN, George W. Johnson, BS, Anne S. Hellkamp, PhD, Per Reinhall, PhD, Jeanne E. Poole, MD, Daniel B. Mark, MD, Kerry L. Lee, PhD and Gust H. Bardy, MD. SCD-HeFT: non-sustained ventricular tachycardia on baseline Holter monitor association with appropriate implantable cardioverter defibrillator therapy for ventricular tachycardia and ventricular fibrillation. J Am Coll Cardiol. 2011;57(14 Supplement):E151. doi:10.1016/S0735-1097(11)60151-4.

  40. Singh SN, Fisher SG, Carson PE, Fletcher RD. Prevalence and significance of nonsustained ventricular tachycardia in patients with premature ventricular contractions and heart failure treated with vasodilator therapy. Department of Veterans Affairs CHF STAT Investigators. J Am Coll Cardiol. 1998;32(4):942–7.

    Article  CAS  PubMed  Google Scholar 

  41. Teerlink JR, Jalaluddin M, Anderson S, Kukin ML, Eichhorn EJ, Francis G, et al. Ambulatory ventricular arrhythmias in patients with heart failure do not specifically predict an increased risk of sudden death. PROMISE (Prospective Randomized Milrinone Survival Evaluation) Investigators. Circulation. 2000;101(1):40–6.

    Article  CAS  Google Scholar 

  42. Chen J, Johnson G, Hellkamp AS, Anderson J, Mark DB, Lee KL, et al. Rapid-rate nonsustained ventricular tachycardia found on implantable cardioverter-defibrillator interrogation: relationship to outcomes in the SCD-HeFT (Sudden Cardiac Death in Heart Failure Trial). J Am Coll Cardiol. 2013;61(21):2161–8. doi:10.1016/j.jacc.2013.02.046.

    Article  PubMed  PubMed Central  Google Scholar 

  43. McClelland RL, Bamlet WR, Glikson M, Friedman PA. Design and analysis issues in cardiac arrhythmia trials: insights from the Detect Supraventricular Tachycardia Trial. Clin Trials. 2007;4(1):74–80. doi:10.1177/1740774506075866.

    Article  PubMed  Google Scholar 

Download references

Author information

Author notes

  1. Dalit Weisman and Roy Beinart contributed equally to the manuscript.

Authors and Affiliations

  1. Leviev Heart Center, Sheba Medical Center, Tel-Hashomer, 52621, Ramat Gan, Israel

    Dalit Weisman, Roy Beinart, Aharon Erez, Ilan Goldenberg, Michael Eldar, Michael Glikson & David Luria

  2. Department of Epidemiology and Preventive Medicine, Tel-Aviv University, Tel-Aviv, Israel

    Dalit Weisman & Nira Koren-Morag

  3. Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel

    Roy Beinart, Ilan Goldenberg, Michael Eldar, Michael Glikson & David Luria

Authors
  1. Dalit Weisman
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Roy Beinart
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Aharon Erez
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nira Koren-Morag
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ilan Goldenberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Michael Eldar
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Michael Glikson
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. David Luria
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Aharon Erez.

Ethics declarations

Ethical statement

The study was approved by the ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

All persons gave their informed consent prior to their inclusion in the study.

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Weisman, D., Beinart, R., Erez, A. et al. Effect of supplemented intake of omega-3 fatty acids on arrhythmias in patients with ICD: fish oil therapy may reduce ventricular arrhythmia. J Interv Card Electrophysiol 49, 255–261 (2017). https://doi.org/10.1007/s10840-017-0267-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10840-017-0267-1

Keywords

Search

Navigation