Randomized Trial to Assess Efficacy of PUFA for the Maintenance of Sinus Rhythm in Persistent Atrial Fibrillation (FORWARD)

• Survival free of atrial fibrillation [ Time Frame: 12 months ] [ Designated as safety issue: Yes ]
  

• Number of patients in sinus rhythm at the time of each study visit [ Time Frame: 12 months ] [ Designated as safety issue: Yes ]
  
• Number of hospitalizations for CV reasons [ Time Frame: 12 months ] [ Designated as safety issue: Yes ]
  
• Number of all-cause hospitalizations [ Time Frame: 12 months ] [ Designated as safety issue: Yes ]
  
• Incidence of TE events [ Time Frame: 12 months ] [ Designated as safety issue: Yes ]
  
• Number of patients who die or with non-fatal thromboembolic events [ Time Frame: 12 months ] [ Designated as safety issue: Yes ]
  

Atrial fibrillation (AF) impose a substantial and growing economic burden on health care expenditures. In patients with persistent AF, there are fundamentally two ways to manage the arrhythmia: to restore and maintain sinus rhythm (rhythm control) or to allow AF to continue and ensure that the ventricular rate is controlled (rate control). As it has been stated, it goes without saying that if we could prevent atrial fibrillation (AF) or restore and maintain sinus rhythm in patients suffering from persistent AF, without any penalties due to the unwanted effects of drugs or incomplete suppression of AF and its thromboembolic complications, every physician would do so. Current strategies however, are limited to achieve such desirable goal. In the last years a growing amount of evidence and attention regarding the cardio-protective role of Omega 3 fatty acids (n-3 PUFA) became progressively clear and appealing.

Epidemiological studies and randomized controlled trials confirms the role of n-3 PUFA in reducing all cause mortality and cardiovascular events mostly in patients at high cardiovascular risk. These effects seems to be mediated mostly by an anti-arrhythmogenic effect.

Basic science confirms and extended clinical observations regarding the antiarrhythmogenic effect of these compounds. Recently both basic research and clinical science suggested a role of n-3 PUFA for the prevention and treatment of supraventricular arrhythmias, particularly AF.

The purpose of the study is to show that the addition of n-3 PUFA on the top of the best recommended therapies can improve the maintenance of normal sinus rhythm in patients with persistent atrial fibrillation.