This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (114)  • Contact me when this article is cited  Related Content  • Related letters  • Similar articles in JAMA  Topic Collections  • Pacemakers/ Defibrillators  • Nutritional and Metabolic Disorders  • Lipids and Lipid Disorders  • Cardiovascular System  • Randomized Controlled Trial  • Arrhythmias  • Cardiovascular Intervention  • Alert me on articles by topic  Social Bookmarking   What's this?

A Randomized Controlled Trial

Merritt H. Raitt, MD; William E. Connor, MD; Cynthia Morris, PhD, MPH; Jack Kron, MD; Blair Halperin, MD; Sumeet S. Chugh, MD; James McClelland, MD; James Cook, MD; Karen MacMurdy, MD; Robert Swenson, MD; Sonja L. Connor; Glenn Gerhard, MD; Dale F. Kraemer, PhD; Daniel Oseran, MD; Christy Marchant, RN, MBA; David Calhoun, RN; Reed Shnider, MD; John McAnulty, MD

JAMA. 2005;293:2884-2891.

Context  Clinical studies of omega-3 polyunsaturated fatty acids (PUFAs) have shown a reduction in sudden cardiac death, suggesting that omega-3 PUFAs may have antiarrhythmic effects.

Objective  To determine whether omega-3 PUFAs have beneficial antiarrhythmic effects in patients with a history of sustained ventricular tachycardia (VT) or ventricular fibrillation (VF).

Design and Setting  Randomized, double-blind, placebo-controlled trial performed at 6 US medical centers with enrollment from February 1999 until January 2003.

Patients  Two hundred patients with an implantable cardioverter defibrillator (ICD) and a recent episode of sustained VT or VF.

Intervention  Patients were randomly assigned to receive fish oil, 1.8 g/d, 72% omega-3 PUFAs, or placebo and were followed up for a median of 718 days (range, 20-828 days).

Main Outcome Measures  Time to first episode of ICD treatment for VT/VF, changes in red blood cell concentrations of omega-3 PUFAs, frequency of recurrent VT/VF events, and predetermined subgroup analyses.

Results  Patients randomized to receive fish oil had an increase in the mean percentage of omega-3 PUFAs in red blood cell membranes from 4.7% to 8.3% (P<.001), with no change observed in patients receiving placebo. At 6, 12, and 24 months, 46% (SE, 5%), 51% (5%), and 65% (5%) of patients randomized to receive fish oil had ICD therapy for VT/VF compared with 36% (5%), 41% (5%), and 59% (5%) for patients randomized to receive placebo (P = .19). In the subset of 133 patients whose qualifying arrhythmia was VT, 61% (SE, 6%), 66% (6%), and 79% (6%) of patients in the fish oil group had VT/VF at 6, 12, and 24 months compared with 37% (6%), 43% (6%), and 65% (6%) of patients in the control group (P = .007). Recurrent VT/VF events were more common in patients randomized to receive fish oil (P<.001).

Conclusion  Among patients with a recent episode of sustained ventricular arrhythmia and an ICD, fish oil supplementation does not reduce the risk of VT/VF and may be proarrhythmic in some patients.

Author Affiliations: Oregon Health and Science University, Portland (Drs Raitt, Connor, Morris, Kron, Chugh, MacMurdy, Gerhard, Kraemer, and McAnulty, Mss Connor and Marchant, and Mr Calhoun), Portland VA Medical Center (Drs Raitt and MacMurdy), St Vincent Medical Center (Drs Halperin and Oseran), and Oregon State University (Dr Kraemer), Portland; Sacred Heart Medical Center, Eugene, Ore (Dr McClelland); Southwest Medical Center, Vancouver, Wash (Dr Swenson); and Baystate Medical Center, Springfield, Mass (Drs Cook and Shnider).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED LETTERS

Fish Oil Supplementation and Arrhythmias
Martin H. Strauss, Paul Dorian, and Subodh Verma
JAMA. 2005;294(17):2165.
EXTRACT | FULL TEXT  

Fish Oil Supplementation and Arrhythmias—Reply
Merritt Raitt, William E. Connor, Cynthia Morris, and John McAnulty
JAMA. 2005;294(17):2165-2166.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Does treatment with n-3 polyunsaturated fatty acids prevent atrial fibrillation after open heart surgery?
Heidarsdottir et al.
Europace 2010;0:eup429v1-eup429.
ABSTRACT | FULL TEXT  

Novel Eicosapentaenoic Acid-derived F3-isoprostanes as Biomarkers of Lipid Peroxidation
Song et al.
J. Biol. Chem. 2009;284:23636-23643.
ABSTRACT | FULL TEXT  

Omega-3 polyunsaturated fatty acids and cardiovascular diseases.
Lavie et al.
J Am Coll Cardiol 2009;54:585-594.
ABSTRACT | FULL TEXT  

Fish consumption, marine omega-3 fatty acids, and incidence of heart failure: a population-based prospective study of middle-aged and elderly men
Levitan et al.
Eur Heart J 2009;30:1495-1500.
ABSTRACT | FULL TEXT  

Do vegetarians have to eat fish for optimal cardiovascular protection?
Mangat
Am. J. Clin. Nutr. 2009;89:1597S-1601S.
ABSTRACT | FULL TEXT  

What can we expect from omega-3 fatty acids?
CHAN and CHO
Cleveland Clinic Journal of Medicine 2009;76:245-251.
ABSTRACT | FULL TEXT  

Effect of fish oil on ventricular tachyarrhythmia in three studies in patients with implantable cardioverter defibrillators
Brouwer et al.
Eur Heart J 2009;30:820-826.
ABSTRACT | FULL TEXT  

Towards Establishing Dietary Reference Intakes for Eicosapentaenoic and Docosahexaenoic Acids
Harris et al.
J. Nutr. 2009;139:804S-819S.
ABSTRACT | FULL TEXT  

Pro-arrhythmic effects of fish oils
Saravanan and Davidson
BMJ 2009;338:b393-b393.
FULL TEXT  

Omega-3 polyunsaturated fatty acids inhibit transient outward and ultra-rapid delayed rectifier K+currents and Na+current in human atrial myocytes
Li et al.
Cardiovasc Res 2009;81:286-293.
ABSTRACT | FULL TEXT  

Ultrafast sodium channel block by dietary fish oil prevents dofetilide-induced ventricular arrhythmias in rabbit hearts
Dujardin et al.
Am. J. Physiol. Heart Circ. Physiol. 2008;295:H1414-H1421.
ABSTRACT | FULL TEXT  

Fish and n-3 fatty acids for the prevention of fatal coronary heart disease and sudden cardiac death
Mozaffarian
Am. J. Clin. Nutr. 2008;87:1991S-1996S.
ABSTRACT | FULL TEXT  

n-3 Fatty acids and cardiovascular disease: mechanisms underlying beneficial effects
Jung et al.
Am. J. Clin. Nutr. 2008;87:2003S-2009S.
ABSTRACT | FULL TEXT  

The Importance of the Omega-6/Omega-3 Fatty Acid Ratio in Cardiovascular Disease and Other Chronic Diseases
Simopoulos
Exp Biol Med 2008;233:674-688.
ABSTRACT | FULL TEXT  

n-3 fatty acids and cardiovascular disease
Grundt and Nilsen
haematol 2008;93:807-812.
FULL TEXT  

Heterogeneity in Randomized Controlled Trials of Long Chain (Fish) Omega-3 Fatty Acids in Restenosis, Secondary Prevention and Ventricular Arrhythmias
Jenkins et al.
J. Am. Coll. Nutr. 2008;27:367-378.
ABSTRACT | FULL TEXT  

Omega-3 Fatty Acids for Cardioprotection
Lee et al.
Mayo Clin Proc. 2008;83:324-332.
ABSTRACT | FULL TEXT  

Acute Administration of Fish Oil Inhibits Triggered Activity in Isolated Myocytes From Rabbits and Patients With Heart Failure
Den Ruijter et al.
Circulation 2008;117:536-544.
ABSTRACT | FULL TEXT  

Fish-oil supplementation in patients with implantable cardioverter defibrillators: a meta-analysis
Jenkins et al.
CMAJ 2008;178:157-164.
ABSTRACT | FULL TEXT  

Should patients with cardiovascular disease take fish oil?
Nair and Connolly
CMAJ 2008;178:181-182.
FULL TEXT  

(n-3) Long Chain PUFA Dose-Dependently Increase Oxygen Utilization Efficiency and Inhibit Arrhythmias after Saturated Fat Feeding in Rats
Pepe and McLennan
J. Nutr. 2007;137:2377-2383.
ABSTRACT | FULL TEXT  

Omega-3 Fatty Acids and Cardiac Arrhythmias: Prior Studies and Recommendations for Future Research: A Report from the National Heart, Lung, and Blood Institute and Office of Dietary Supplements Omega-3 Fatty Acids and Their Role in Cardiac Arrhythmogenesis Workshop
London et al.
Circulation 2007;116:e320-e335.
FULL TEXT  

Systematic Review: Implantable Cardioverter Defibrillators for Adults with Left Ventricular Systolic Dysfunction
Ezekowitz et al.
ANN INTERN MED 2007;147:251-262.
ABSTRACT | FULL TEXT  

{alpha}-Linolenic acid and fish oil n 3 fatty acids and cardiovascular disease risk
Vos et al.
Am. J. Clin. Nutr. 2007;85:920-921.
FULL TEXT  

Recommending Omega-3 Oils for Patients With Heart Risks
DOC News 2007;4:4-4.
FULL TEXT  

Cardiovascular benefits of omega-3 fatty acids
von Schacky and Harris
Cardiovasc Res 2007;73:310-315.
ABSTRACT | FULL TEXT  

Pro- and antiarrhythmic properties of a diet rich in fish oil
Den Ruijter et al.
Cardiovasc Res 2007;73:316-325.
ABSTRACT | FULL TEXT  

Dietary n-3 fatty acids promote arrhythmias during acute regional myocardial ischemia in isolated pig hearts
Coronel et al.
Cardiovasc Res 2007;73:386-394.
ABSTRACT | FULL TEXT  

{alpha}-Linolenic Acid-Enriched Diet Prevents Myocardial Damage and Expands Longevity in Cardiomyopathic Hamsters
Fiaccavento et al.
Am. J. Pathol. 2006;169:1913-1924.
ABSTRACT | FULL TEXT  

The Year in Epidemiology, Health Services Research, and Outcomes Research
Krumholz and Masoudi
J Am Coll Cardiol 2006;48:1886-1895.
FULL TEXT  

Fish intake, contaminants, and human health: evaluating the risks and the benefits.
Mozaffarian and Rimm
JAMA 2006;296:1885-1899.
ABSTRACT | FULL TEXT  

Polyunsaturated Fatty Acids and the Post-Infarct Patient: A Recipe for Baroreflex Health?
Floras and Bagai
J Am Coll Cardiol 2006;48:1607-1609.
FULL TEXT  

Enhanced Baroreceptor Control of the Cardiovascular System by Polyunsaturated Fatty Acids in Heart Failure Patients
Radaelli et al.
J Am Coll Cardiol 2006;48:1600-1606.
ABSTRACT | FULL TEXT  

ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death)
Developed in Collaboration With the European Heart et al.
J Am Coll Cardiol 2006;48:e247-e346.
FULL TEXT  

ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: A report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society
Writing Committee Members et al.
Europace 2006;8:746-837.
FULL TEXT  

Impact of Dietary Patterns and Interventions on Cardiovascular Health
Zarraga and Schwarz
Circulation 2006;114:961-973.
FULL TEXT  

Dietary Fish and n-3 Fatty Acid Intake and Cardiac Electrocardiographic Parameters in Humans
Mozaffarian et al.
J Am Coll Cardiol 2006;48:478-484.
ABSTRACT | FULL TEXT  

n-3 Fatty acids from fish or fish-oil supplements, but not {alpha}-linolenic acid, benefit cardiovascular disease outcomes in primary- and secondary-prevention studies: a systematic review
Wang et al.
Am. J. Clin. Nutr. 2006;84:5-17.
ABSTRACT | FULL TEXT  

(n-3) Long-Chain Polyunsaturated Fatty Acids Prolong Survival following Myocardial Infarction in Rats
Zaloga et al.
J. Nutr. 2006;136:1874-1878.
ABSTRACT | FULL TEXT  

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.
Brouwer et al.
JAMA 2006;295:2613-2619.
ABSTRACT | FULL TEXT  

n-3 Fatty acids and cardiovascular disease
Breslow
Am. J. Clin. Nutr. 2006;83:S1477-1482S.
ABSTRACT | FULL TEXT  

n-3 Fatty acid dietary recommendations and food sources to achieve essentiality and cardiovascular benefits
Gebauer et al.
Am. J. Clin. Nutr. 2006;83:S1526-1535S.
ABSTRACT | FULL TEXT  

Successful treatment of drug refractory ventricular tachycardia by omega-3 fatty acid supplementation
Jenkins et al.
Europace 2006;8:330-332.
ABSTRACT | FULL TEXT  

Oily fish and omega 3 fat supplements
Brunner
BMJ 2006;332:739-740.
FULL TEXT  

Other articles noted
Evid. Based Med. 2005;10:191-192.
FULL TEXT  

Hotline Sessions of the 27th European Congress of Cardiology
Keuper and Verheugt
Eur Heart J 2005;26:2596-2599.
FULL TEXT  

Fish Oil Supplementation and Arrhythmias
Strauss et al.
JAMA 2005;294:2165-2165.
FULL TEXT  

Prevention of Fatal Arrhythmias in High-Risk Subjects by Fish Oil n-3 Fatty Acid Intake
Leaf et al.
Circulation 2005;112:2762-2768.
ABSTRACT | FULL TEXT  

JournalScan
Heart 2005;91:1246-1248.
FULL TEXT  

Hold the Fish Oil for Patients with ICDs
Journal Watch Cardiology 2005;2005:1-1.
FULL TEXT