Meta-Analysis of n-3 Polyunsaturated Fatty Acid Supplementation for the Prevention of Post-Operative Atrial Fibrillation in Patients Undergoing Coronary Artery Bypass Surgery

Background Several randomized clinical trials (RCTs) have evaluated whether pre-operative supplementation of omega-3 (n-3) polyunsaturated fatty acids (PUFA) protects against postoperative atrial fibrillation (POAF) after coronary artery bypass surgery (CABG). However, the efficacy of this intervention remains controversial. We performed a meta-analysis to determine if PUFA supplementation prevents POAF. Methods A systematic literature search was performed (through December 20, 2018) using PubMed, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials to identify RCTs evaluating PUFA supplementation for post-CABG POAF prevention. The primary outcome was the incidence of POAF. For each study, the incidence of AF in the intervention and placebo groups was extracted to calculate odds ratio and 95% confidence intervals (CIs). Mantel-Haenszel random effects model was used to summarize data across treatment arms. Heterogeneity between the studies was assessed using the chi square test and was considered significant if p values 50%. Results We identified 11 RCTs that included a total of 3,127 participants (1,557 in the PUFA group and 1,570 in the placebo group). Pooled analysis demonstrated a significant reduction in POAF in patients treated with PUFA as compared to placebo (OR 0.66; 95% CI, 0.48-0.90; p=0.008). The estimated number-needed-to-treat was 18 (95% CI 11.53-45.67). The test of heterogeneity was significant (I262%, p = 0.003). Conclusions Preoperative supplementation of omega-3 (n-3) polyunsaturated fatty acids reduces the incidence of POAF in patients undergoing CABG surgery.