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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).

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Fish Oil Supplementation and Arrhythmias
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