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Fish-oil supplementation in patients with implantable cardioverter defibrillators: a meta-analysis Jenkins DJ; Josse AR; Beyene J; Dorian P; Burr ML; LaBelle R; Kendall CW; Cunnane SCCMAJ 2008[Jan]; 178 (2): 157-64BACKGROUND: 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.|*Death[MESH]|*Defibrillators, Implantable[MESH]|*Dietary Supplements[MESH]|Adult[MESH]|Aged[MESH]|Female[MESH]|Fish Oils/*administration & dosage/adverse effects[MESH]|Follow-Up Studies[MESH]|Humans[MESH]|Male[MESH]|Middle Aged[MESH]|Myocardial Infarction/prevention & control[MESH]|Primary Prevention/methods[MESH]|Randomized Controlled Trials as Topic[MESH]|Reference Values[MESH]|Risk Assessment[MESH]|Survival Rate[MESH]|Tachycardia, Ventricular/diagnosis/mortality/*therapy[MESH]|Treatment Outcome[MESH] |
