Atrial fibrillation (AF) is the most common type of arrhythmia in adults, accounting for about one third of total arrhythmia-related hospitalizations. AF impact on daily clinical practice is steadily rising, together with population aging and increased survival from underlying conditions closely associated with AF such as coronary heart disease and heart failure. Although antiarrhythmic therapy, oral anticoagulation, implanted device therapy, and ablation techniques are now all common and promptly available strategies in AF management, some of them are burdened by a low efficacy rate, while others are associated with increased proarrhythmic or hemorrhagic risk. Consequently, useful alternatives are being sought. Between those, polyunsaturated fatty acids (n-3 PUFAs) have risen from mere alternative to statins in dyslipidemia management to powerful and well-tolerated antiinflammatory, antithrombotic, and antiarrhythmogenic drugs.
From the evidence collected through basic science studies, whether on in vivo myocytes, animal models, or surrogate end points in human, n-3 PUFAs seem to offer innumerable advantages. On the other hand, epidemiological and clinical trials failed to demonstrate a clear efficacy of n-3 PUFAs as antiarrhythmic drugs, although covered by an optimal safety profile. The aim of the present review is to summarize the most important evidences currently available on the role of n-3 PUFA in AF management and therapy.