Palaniappan Saravanan

Cardiovascular effects of marine omega-3 fatty acids.

Much evidence shows that the marine omega-3 fatty acids eicosapentaenoic acid and docosahexaenoic acid have beneficial effects in various cardiac disorders, and their use is recommended in guidelines for management of patients after myocardial infarction. However, questions have been raised about their usefulness alongside optimum medical therapies with agents proven to reduce risk of cardiac events in high-risk patients. Additionally, there is some evidence for a possible pro-arrhythmic effect in subsets of cardiac patients. Some uncertainly exists about the optimum dose needed to obtain beneficial effects and the relative merit of dietary intake of omega-3 polyunsaturated fatty acids versus supplements. We review evidence for the effects of omega-3 polyunsaturated fatty acids on various cardiac disorders and the risk factors for cardiac disease. We also assess areas of uncertainty needing further research.

Omega-3 Fatty Acid Supplementation Does Not Reduce Risk of Atrial Fibrillation After Coronary Artery Bypass Surgery A Randomized, Double-Blind, Placebo-Controlled Clinical Trial

Background—Omega-3 polyunsaturated fatty acids (n-3 PUFA) have been reported to reduce the risk of sudden cardiac death presumed to be due to fatal ventricular arrhythmias, but their effect on atrial arrhythmias is unclear. Methods and Results—Patients (n=108) undergoing coronary artery bypass graft surgery were randomly assigned to receive 2 g/d n-3 PUFA or placebo (olive oil) for at least 5 days before surgery (median, 16 days; range, 12 to 21 days). Phospholipid n-3 PUFA were measured in serum at study entry and at surgery and in right atrial appendage tissue at surgery. Echocardiography was used to assess left ventricular function and left atrial dimensions. Postoperative continuous ECG monitoring (Lifecard CF) for 5 days or until discharge, if earlier, was performed with a daily 12-lead ECG and clinical review if patients remained in the hospital beyond 5 days. Lifecard recordings were analyzed for episodes of atrial fibrillation (AF) ≥30 seconds (primary outcome). Clinical AF, AF burden (% time in AF), hospital stay, and intensive care/high dependency care stay were measured as secondary outcomes. One hundred three patients completed the study (51 in the placebo group and 52 in the n-3 PUFA group). There were no clinically relevant differences in baseline characteristics between groups. n-3 PUFA levels were higher in serum and right atrial tissue in the active treatment group. There was no significant difference between groups in the primary outcome of AF (95% confidence interval [CI], −6% to 30%, P=0.28) in any of the secondary outcomes or in AF-free survival. Conclusions—Omega-3 PUFA do not reduce the risk of AF after coronary artery bypass graft surgery. Clinical Trial Registration—www.ukcrn.org.uk. Identifier: 4437.

Risk assessment for sudden cardiac death in dialysis patients: How relevant are conventional cardiac risk factors?

Patients with end stage renal disease on long term dialysis support have a very high risk of sudden cardiac death (SCD) presumably due to serious ventricular arrhythmias. Implantable cardioverter defibrillators (ICD) can be life saving in patients with SCD but their role in dialysis patients is unclear. Much of the current evidence on this important clinical issue limits to retrospective analysis of patients who received an ICD for conventional cardiac indication. It appears that there are certain factors that are unique to patients with renal failure which pre-disposes them to such high incidence of SCD and by applying the conventional risk assessment model on this sub-group of patients we are likely to miss a significant proportion of patients who would not fulfil that criteria but would be at high risk of SCD. In order to clarify this issue, we performed a retrospective screening of patients with end stage renal disease on haemodialysis using conventional risk assessment model and compared the outcome with the known incidence of SCD in this sub-group.

Migraine Following Trans‐Septal Access for Catheter Ablation of Cardiac Arrhythmias

There is increasing recognition that migraine with aura may be associated with intra‐cardiac shunting because of a patent foramen ovale. Radio‐frequency ablation to treat cardiac arrhythmias is an increasingly popular means of treating cardiac arrhythmias. Trans‐septal puncture is routinely performed to gain access to the left atrium in order to ablate arrhythmias originating in the left heart. We report several cases of migraine triggered acutely by trans‐septal puncture at our center.

The Role of Omega-3 Fatty Acids in Primary Prevention of Coronary Artery Disease and in Atrial Fibrillation Is Controversial

We read with interest a recent review article on the cardiovascular effects of omega-3 fatty acids (ω-3 PUFA) by Lavie et al. ([1][1]) and wish to highlight some of the controversial issues in this review. In relation to the role of ω-3 PUFA in primary prevention of coronary artery disease (CAD),

Pro-arrhythmic effects of fish oils

In their systematic review of the effect of fish oils on arrhythmia and mortality, Leon and colleagues did not mention the potential for fish oils to be pro-arrhythmic in some subgroups of patients with heart disease.1 In animal experiments and cellular electrophysiological studies fish oils …

Omega-3 Fatty Acid Supplementation Does Not Reduce Risk of Atrial Fibrillation After Coronary Artery Bypass SurgeryCLINICAL PERSPECTIVE

Background—Omega-3 polyunsaturated fatty acids (n-3 PUFA) have been reported to reduce the risk of sudden cardiac death presumed to be due to fatal ventricular arrhythmias, but their effect on atrial arrhythmias is unclear. Methods and Results—Patients (n=108) undergoing coronary artery bypass graft surgery were randomly assigned to receive 2 g/d n-3 PUFA or placebo (olive oil) for at least 5 days before surgery (median, 16 days; range, 12 to 21 days). Phospholipid n-3 PUFA were measured in serum at study entry and at surgery and in right atrial appendage tissue at surgery. Echocardiography was used to assess left ventricular function and left atrial dimensions. Postoperative continuous ECG monitoring (Lifecard CF) for 5 days or until discharge, if earlier, was performed with a daily 12-lead ECG and clinical review if patients remained in the hospital beyond 5 days. Lifecard recordings were analyzed for episodes of atrial fibrillation (AF) ≥30 seconds (primary outcome). Clinical AF, AF burden (% time in AF), hospital stay, and intensive care/high dependency care stay were measured as secondary outcomes. One hundred three patients completed the study (51 in the placebo group and 52 in the n-3 PUFA group). There were no clinically relevant differences in baseline characteristics between groups. n-3 PUFA levels were higher in serum and right atrial tissue in the active treatment group. There was no significant difference between groups in the primary outcome of AF (95% confidence interval [CI], −6% to 30%, P=0.28) in any of the secondary outcomes or in AF-free survival. Conclusions—Omega-3 PUFA do not reduce the risk of AF after coronary artery bypass graft surgery. Clinical Trial Registration—www.ukcrn.org.uk. Identifier: 4437.

Omega-3 Fatty Acid Supplementation Does Not Reduce Risk of Atrial Fibrillation After Coronary Artery Bypass SurgeryCLINICAL PERSPECTIVE: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial

Background—Omega-3 polyunsaturated fatty acids (n-3 PUFA) have been reported to reduce the risk of sudden cardiac death presumed to be due to fatal ventricular arrhythmias, but their effect on atrial arrhythmias is unclear. Methods and Results—Patients (n=108) undergoing coronary artery bypass graft surgery were randomly assigned to receive 2 g/d n-3 PUFA or placebo (olive oil) for at least 5 days before surgery (median, 16 days; range, 12 to 21 days). Phospholipid n-3 PUFA were measured in serum at study entry and at surgery and in right atrial appendage tissue at surgery. Echocardiography was used to assess left ventricular function and left atrial dimensions. Postoperative continuous ECG monitoring (Lifecard CF) for 5 days or until discharge, if earlier, was performed with a daily 12-lead ECG and clinical review if patients remained in the hospital beyond 5 days. Lifecard recordings were analyzed for episodes of atrial fibrillation (AF) ≥30 seconds (primary outcome). Clinical AF, AF burden (% time in AF), hospital stay, and intensive care/high dependency care stay were measured as secondary outcomes. One hundred three patients completed the study (51 in the placebo group and 52 in the n-3 PUFA group). There were no clinically relevant differences in baseline characteristics between groups. n-3 PUFA levels were higher in serum and right atrial tissue in the active treatment group. There was no significant difference between groups in the primary outcome of AF (95% confidence interval [CI], −6% to 30%, P=0.28) in any of the secondary outcomes or in AF-free survival. Conclusions—Omega-3 PUFA do not reduce the risk of AF after coronary artery bypass graft surgery. Clinical Trial Registration—www.ukcrn.org.uk. Identifier: 4437.