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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EPostoperative atrial fibrillation (AF) flutter occurs in approximately 1 of 3 patients undergoing cardiac surgery [Hogue CW Jr et al. \u003Cem\u003EChest\u003C\/em\u003E 2005; Mitchell LB et al. \u003Cem\u003ECan J Cardiol\u003C\/em\u003E 2011], generating a need for new therapies to prevent it and its associated morbidity and healthcare costs [Mozaffarian D et al. \u003Cem\u003EJAMA\u003C\/em\u003E 2012]. This article discusses findings from the Omega-3 Fatty Acids for Prevention of Post-Operative Atrial Fibrillation trial [OPERA; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00970489\u0026amp;atom=%2Fspmdc%2F12%2F18%2F10.atom\u0022\u003ENCT00970489\u003C\/a\u003E].\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EArrhythmias\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EPostoperative atrial fibrillation (AF) flutter occurs in approximately 1 of 3 patients undergoing cardiac surgery [Hogue CW Jr et al. \u003Cem\u003EChest\u003C\/em\u003E 2005; Mitchell LB et al. \u003Cem\u003ECan J Cardiol\u003C\/em\u003E 2011], generating a need for new therapies to prevent it and its associated morbidity and healthcare costs [Mozaffarian D et al. \u003Cem\u003EJAMA\u003C\/em\u003E 2012]. Roberto Marchioli, MD, MPH, Consorzio Mario Negri Sud, Santa Maria Imbaro, Italy, reported findings from the Omega-3 Fatty Acids for Prevention of Post-Operative Atrial Fibrillation trial [OPERA; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00970489\u0026amp;atom=%2Fspmdc%2F12%2F18%2F10.atom\u0022\u003ENCT00970489\u003C\/a\u003E], which were simultaneously published in the \u003Cem\u003EJournal of the American Medical Association\u003C\/em\u003E online [Mozaffarian D et al. \u003Cem\u003EJAMA\u003C\/em\u003E 2012].\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EA few small trials have evaluated whether long-chain n-3 polyunsaturated fatty acids (PUFAs) reduce postoperative AF, with mixed results. The purpose of OPERA, a large multinational, randomized, double-blind, placebo-controlled clinical trial, was to examine whether perioperative intake of n-3 PUFAs would reduce the occurrence of postoperative AF in cardiac surgery patients aged \u226518 years scheduled for cardiac surgery on the following day or later who had sinus rhythm on screening electrocardiogram (ECG).\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EThe primary endpoint was any postoperative AF \u0026gt;30 seconds duration confirmed by rhythm strip or 12-lead ECG. Secondary endpoints were postoperative AF lasting longer than 1 hour resulting in symptoms or treated with cardioversion; postoperative AF, excluding atrial flutter; time to first postoperative AF; number of AF episodes per patient; hospital utilization; and major adverse cardiovascular events, 30-day mortality, bleeding, and other adverse events [Mozaffarian D et al. \u003Cem\u003EJAMA\u003C\/em\u003E 2012].\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EA total of 1516 patients undergoing cardiac surgery in 28 centers in the United States, Italy, and Argentina were randomized to receive fish oil (1 g capsules containing \u2265840 mg n-3 PUFAs as ethyl esters) or placebo, with preoperative loading of 10 g over 3 to 5 days (or 8 g over 2 days) followed postoperatively by 2 g\/day until hospital discharge or postoperative Day 10, whichever came first.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EThe average age of enrolled patients was 64 years; 72.2% were men and 51.8% had planned valvular surgery. The primary endpoint occurred in 233 (30.7%) patients assigned to placebo versus 227 (30.0%) assigned to n-3 PU FA s (OR, 0.96; 95% CI, 0.77 to 1.20; p=0.74; \u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E). None of the secondary endpoints were significantly different between the placebo and fish oil groups, including postoperative AF that was sustained, symptomatic, or treated (231 [30.5%] vs 224 [29.6%]; p=0.70) or number of postoperative AF episodes per patient (1 episode: 156 [20.6%] vs 157 [20.7%]; 2 episodes: 59 [7.8%] vs 49 [6.5%]; or \u22653 episodes: 18 [2.4%] vs 21 [2.8%]; p=0.73).\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EOther secondary endpoints were not significant: postoperative AF excluding atrial flutter (p=0.87), total number of days with any postoperative AF (p=0.58), and proportion of days free of postoperative AF (p=0.882).\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/18\/10\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022OPERA Primary Endpoint: Postoperative AF Episodes.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-552228549\u0022 data-figure-caption=\u0022OPERA Primary Endpoint: Postoperative AF Episodes.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/18\/10\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/18\/10\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/18\/10\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/13043\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-8\u0022 class=\u0022first-child\u0022\u003EOPERA Primary Endpoint: Postoperative AF Episodes.\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EReproduced with permission from R Marchioli, MD, MPH, and D Mozaffarian, MD, PhD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-9\u0022\u003EBased on the data, Prof. Marchioli concluded that postoperative AF remains an enigmatic and difficult-to-prevent complication of cardiac surgery. While n-3 PUFA appeared to be safe and well-tolerated with no evidence of increased bleeding, the OPERA trial \u201cprovides evidence that perioperative n-3 PUFA does not appreciably reduce postoperative AF in the acute setting of cardiac surgery.\u201d\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2012 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/12\/18\/10.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzn5y2\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzn5y2\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}