TY - JOUR T1 - Fish-oil supplementation in patients with implantable cardioverter defibrillators: a meta-analysis JF - Canadian Medical Association Journal JO - CMAJ SP - 157 LP - 164 DO - 10.1503/cmaj.070261 VL - 178 IS - 2 AU - David J.A. Jenkins, MD PhD AU - Andrea R. Josse, MSc AU - Joseph Beyene, PhD AU - Paul Dorian, MD MSc AU - Michael L. Burr, MD DSc (Med) AU - Roxanne LaBelle, BSc AU - Cyril W.C. Kendall, PhD AU - Stephen C. Cunnane, PhD Y1 - 2008/01/15 UR - http://www.cmaj.ca/content/178/2/157.abstract N2 - 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. ER -