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Fish-oil supplementation in patients with implantable cardioverter defibrillators: a meta-analysis

From the Clinical Nutrition and Risk Factor Modification Centre (Josse, LaBelle, Kendall) and the Department of Medicine and Divisions of Endocrinology and Metabolism (Jenkins) and Cardiology (Dorian), St. Michael's Hospital, Toronto, Ont.; the Departments of Nutritional Sciences (Jenkins, Josse, LaBelle, Kendall) and Biostatistics (Beyene), University of Toronto, Toronto, Ont.; Department of Primary Care and Public Health (Burr), Cardiff University, Wales, United Kingdom; and the Research Centre on Aging (Cunnane), Université de Sherbrooke, Sherbrooke, Que.

Correspondence to: Dr. David J.A. Jenkins, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, 61 Queen St. East, Toronto ON M5C 2T2; fax 416 978-5310; cyril.kendall{at}utoronto.ca

Background: A recent Cochrane meta-analysis did not confirm the benefits of fish and fish oil in the secondary prevention of cardiac death and myocardial infarction. We performed a meta-analysis of randomized controlled trials that examined the effect of fish-oil supplementation on ventricular fibrillation and ventricular tachycardia to determine the overall effect and to assess whether heterogeneity exists between trials.

Methods: We searched electronic databases (MEDLINE, EMBASE, The Cochrane Central Register of Controlled Trials, CINAHL) from inception to May 2007. We included randomized controlled trials of fish-oil supplementation on ventricular fibrillation or ventricular tachycardia in patients with implantable cardioverter defibrillators. The primary outcome was implantable cardioverter defibrillator discharge. We calculated relative risk [RR] for outcomes at 1-year follow-up for each study. We used the DerSimonian and Laird random-effects methods when there was significant heterogeneity between trials and the Mantel-Hanzel fixed-effects method when heterogeneity was negligible.

Results: We identified 3 trials of 1–2 years' duration. These trials included a total of 573 patients who received fish oil and 575 patients who received a control. Meta-analysis of data collected at 1 year showed no overall effect of fish oil on the relative risk of implantable cardioverter defibrillator discharge. There was significant heterogeneity between trials. The second largest study showed a significant benefit of fish oil (relative risk [RR] 0.74, 95% confidence interval [CI] 0.56–0.98). The smallest showed an adverse tendency at 1 year (RR 1.23, 95% CI 0.92–1.65) and significantly worse outcome at 2 years among patients with ventricular tachycardia at study entry (log rank p = 0.007).

Conclusion: These data indicate that there is heterogeneity in the response of patients to fish-oil supplementation. Caution should be used when prescribing fish-oil supplementation for patients with ventricular tachycardia.

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