The impact of Omega-3 supplementation on arrhythmia reduction in acute coronary syndrome patients: a randomized clinical trial

Roholla Hemmati; Dorsa Bahrami Zanjanbar; Mohammad Iman Shishesaz; Abbas Soleimani; Tahereh Yari

doi:10.1515/jcim-2024-0427

Article

The impact of Omega-3 supplementation on arrhythmia reduction in acute coronary syndrome patients: a randomized clinical trial

Roholla Hemmati , Dorsa Bahrami Zanjanbar , Mohammad Iman Shishesaz , Abbas Soleimani and Tahereh Yari

Published/Copyright: January 13, 2025

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From the journal Journal of Complementary and Integrative Medicine Volume 22 Issue 1

Abstract

Background and Objectives

Cardiovascular diseases (CVDs), including acute coronary syndrome (ACS), represent a major global health challenge. Arrhythmias such as ventricular tachycardia (VT), ventricular fibrillation (VF), atrial fibrillation (AF), premature ventricular contractions (PVCs), and premature atrial contractions (PACs) frequently complicate ACS, needing effective management strategies. Omega-3 fatty acids have shown potency in preventing sudden cardiac death by modulating arrhythmias, but their acute effects in ACS patients remain controversial. This study aimed to evaluate the impact of Omega-3 supplementation on reducing common arrhythmias among ACS patients.

Methods

A randomized clinical trial involving 74 ACS patients was conducted. Participants were randomly assigned to receive either 1 gr of Omega-3 daily or placebo (olive oil capsules) for five days. Arrhythmia frequencies (AF, PVCs, PACs, VT, VF) were monitored using daily ECGs, and statistical analyses were performed using SPSS software (version 24).

Results

Over the five days, patients receiving Omega-3 showed significant reductions in the occurrence of AF (26.66–11.66 %, p=0.015), PACs (21.66–3.33 %, p=0.043), and PVCs (36.66–3.33 %, p=0.021) compared to the control group. The frequency of VT and VF cases was low, with only one VT case in the Omega-3 group, which resolved without intervention after the second day.

Conclusions

This study highlights the potential of Omega-3 fatty acids as adjunct therapy for arrhythmia management post-ACS, particularly in reducing AF, PACs, and PVCs. However, the minimal effects on VF and VT and the lack of thorough statistical analysis for these arrhythmias warrant further investigation.

Keywords: acute coronary syndrome; arrhythmias; ventricular arrhythmia; atrial arrhythmia; omega-3

Corresponding author: Dr. Roholla Hemmati, Assistant Professor, Department of Cardiology, School of Medicine, Ilam University of Medical Sciences, Ilam, Iran, E-mail: rouhollahhemmati8@gmail.com

Research ethics: Oral consent was obtained from the patients and it was also approved by the Ethics Committee of Ilam University of Medical Sciences.
Informed consent: Informed consent was obtained from all individuals included in this study, or their legal guardians or wards.
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Use of Large Language Models, AI and Machine Learning Tools: None declared.
Conflict of interest: The authors state no conflict of interest.
Research funding: None declared.
Data availability: Not applicable.

References

1. World Health Organization (WHO). WHO reveals leading causes of death and disability worldwide. World Health Organization; 2021. Available from: https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds).Search in Google Scholar

2. Gaziano, TA. Cardiovascular disease in the developing world and its cost-effective management. Circulation 2005;112:3547–53. https://doi.org/10.1161/circulationaha.105.591792.Search in Google Scholar PubMed

3. Mc Namara, K, Alzubaidi, H, Jackson, JK. Cardiovascular disease as a leading cause of death: how are pharmacists getting involved? Integr pharm Res Pract 2019:1–11, https://doi.org/10.2147/IPRP.S133088.Search in Google Scholar PubMed PubMed Central

4. Simons, M, Alpert, J, Cannon, C. Acute coronary syndrome: terminology and classification. Waltham, MA: UpToDate Inc; 2020.Search in Google Scholar

5. Bhatt, DL, Lopes, RD, Harrington, RA. Diagnosis and treatment of acute coronary syndromes: a review. JAMA 2022;327:662–75. https://doi.org/10.1001/jama.2022.0358.Search in Google Scholar PubMed

6. Thomas, D, Jex, N, Thornley, A. Ventricular arrhythmias in acute coronary syndromes–mechanisms and management. Contin Cardiol Educ 2017;3:22–9. https://doi.org/10.1002/cce2.51.Search in Google Scholar

7. Piccini, JP, White, JA, Mehta, RH, Lokhnygina, Y, Al-Khatib, SM, Tricoci, P, et al.. Sustained ventricular tachycardia and ventricular fibrillation complicating non–ST-segment–elevation acute coronary syndromes. Circulation 2012;126:41–9. https://doi.org/10.1161/circulationaha.111.071860.Search in Google Scholar PubMed

8. Rubenstein, JC, Cinquegrani, MP, Wright, J. Atrial fibrillation in acute coronary syndrome. J Atr Fibrillation 2012;5. https://doi.org/10.4022/jafib.551.Search in Google Scholar PubMed PubMed Central

9. Whang, W, Peacock, J, Soto, AV, Borda, T, Bhatt, AB, Richardson, SI, et al.. Relationship between premature ventricular complexes and depressive symptoms in non-ST-elevation acute coronary syndrome. Eur Heart J: Acute Cardiovasc Care 2013;2:61–7. https://doi.org/10.1177/2048872613476101.Search in Google Scholar PubMed PubMed Central

10. Liu, HY, Wu, JY, Chung, CP, Lee, IH, Lin, CJ, Lin, CJ, et al.. Premature atrial contractions and their association with stroke features and outcome. J Stroke Cerebrovasc Dis 2020;29. https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.105118.Search in Google Scholar PubMed

11. Crea, F, Libby, P. Acute coronary syndromes: the way forward from mechanisms to precision treatment. Circulation 2017;136:1155–66. https://doi.org/10.1161/circulationaha.117.029870.Search in Google Scholar

12. Ebbesson, SO, Devereux, RB, Cole, S, Ebbesson, LO, Fabsitz, RR, Haack, K, et al.. Heart rate is associated with red blood cell fatty acid concentration: the Genetics of Coronary Artery Disease in Alaska Natives (GOCADAN) study. Am Heart J 2010;159:1020–5. https://doi.org/10.1016/j.ahj.2010.03.001.Search in Google Scholar PubMed PubMed Central

13. He, K. Fish, long-chain omega-3 polyunsaturated fatty acids and prevention of cardiovascular disease–eat fish or take fish oil supplement? Prog Cardiovasc Dis 2009;52:95–114. https://doi.org/10.1016/j.pcad.2009.06.003.Search in Google Scholar PubMed

14. Smith, PJ, Blumenthal, JA, Babyak, MA, Georgiades, A, Sherwood, A, Sketch, MHJr, et al.. Association between n-3 fatty acid consumption and ventricular ectopy after myocardial infarction. Am J Clin Nutr 2009;89:1315–20. https://doi.org/10.3945/ajcn.2008.26829.Search in Google Scholar PubMed PubMed Central

15. Harris, WS, von Schacky, C. Omega-3 fatty acids, acute coronary syndrome, and sudden death. Curr Cardiovasc Risk Rep 2008;2:161–6. https://doi.org/10.1007/s12170-008-0029-9.Search in Google Scholar

16. Cheng, JW, Santoni, F. Omega-3 fatty acid: a role in the management of cardiac arrhythmias? J Alternative Compl Med 2008;14:965–74. https://doi.org/10.1089/acm.2007.0765.Search in Google Scholar PubMed

17. Wang, C, Harris, WS, Chung, M, Lichtenstein, AH, Balk, EM, Kupelnick, B, et al.. n−3 Fatty acids from fish or fish-oil supplements, but not α-linolenic acid, benefit cardiovascular disease outcomes in primary-and secondary-prevention studies: a systematic review. Am J Clin Nutr 2006;84:5–17. https://doi.org/10.1093/ajcn/84.1.5.Search in Google Scholar PubMed

18. Mozaffarian, D, Rimm, EB. Fish intake, contaminants, and human health: evaluating the risks and the benefits. JAMA 2006;296:1885–99. https://doi.org/10.1001/jama.296.15.1885.Search in Google Scholar PubMed

19. Wu, JH, Lemaitre, RN, King, IB, Song, X, Sacks, FM, Rimm, EB, et al.. Association of plasma phospholipid long-chain omega-3 fatty acids with incident atrial fibrillation in older adults: the cardiovascular health study. Circulation 2012;125:1084–93. https://doi.org/10.1161/circulationaha.111.062653.Search in Google Scholar

20. Von Schacky, C. Omega-3 Fatty acids: anti-arrhythmic, pro-arrhythmic, or both? Front Physiol 2012;3:20885. https://doi.org/10.3389/fphys.2012.00088.Search in Google Scholar PubMed PubMed Central

21. Saravanan, P, Bridgewater, B, West, AL, O’Neill, SC, Calder, PC, Davidson, NC. 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. Circ: Arrhythmia Electrophysiol 2010;3:46–53. https://doi.org/10.1161/circep.109.899633.Search in Google Scholar PubMed

22. Nifontov, E, Shikhaliev, D, Bogachev, M, Krasichkov, A, Shliakhto, E. Antiarrhythmic activity of omega-3 polyunsaturated fatty acids in patients with stable ischemic heart disease and ventricular rhythm disturbances. Kardiologiia 2010;50:4–9.Search in Google Scholar

23. Anand, RG, Alkadri, M, Lavie, CJ, Milani, RV. The role of fish oil in arrhythmia prevention. J Cardpulm Rehabil Prev 2008;28:92–8. https://doi.org/10.1097/01.hcr.0000314202.09676.f0.Search in Google Scholar PubMed

24. Buchhorn, R, Baumann, C, Willaschek, C. Alleviation of arrhythmia burden in children with frequent idiopathic premature ventricular contractions by omega-3-fatty acid supplementation. Int J Cardiol 2019;291:52–6. https://doi.org/10.1016/j.ijcard.2019.05.054.Search in Google Scholar PubMed

25. Oner, T, Ozdemir, R, Doksöz, O, Genc, DB, Guven, B, Demirpence, S, et al.. Cardiac function in children with premature ventricular contractions: the effect of omega-3 polyunsaturated fatty acid supplementation. Cardiol Young 2018;28:949–54. https://doi.org/10.1017/s1047951118000574.Search in Google Scholar

Received: 2024-11-25

Accepted: 2024-12-09

Published Online: 2025-01-13

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Articles in the same Issue

https://doi.org/10.1515/jcim-2024-0427

Keywords for this article

acute coronary syndrome; arrhythmias; ventricular arrhythmia; atrial arrhythmia; omega-3