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In Reply: We agree with Drs Strauss, Dorian, and Verma that our finding of a trend toward an increased risk of ventricular arrhythmias in patients with ICDs assigned to fish oil must be put into context. The GISSI trial¹ and other studies in patients with recent myocardial infarction provide good evidence that in this group fish oil supplementation reduces mortality and that this is likely due to the suppression of ischemic VF.

Because ICDs are not usually implanted in patients who have had ischemic VF, our results are more likely due to an adverse effect of fish oil on scar-based reentry. An important question is what effect fish oil supplementation has in patients with coronary artery disease who have had neither a recent myocardial infarction nor an arrhythmia leading to ICD implantation. The American Heart Association has indeed recommended that physicians consider omega-3 supplements in all patients with documented coronary . . . [Full Text of this Article]

Merritt Raitt, MD
merritt.raitt@med.va.gov
Portland VA Medical Center
Portland, Ore

William E. Connor, MD; Cynthia Morris, PhD, MPH; John McAnulty, MD
Oregon Health and Science University
Portland, Ore

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