Substitute for coumadin?

Is it possible to have an exact diet every day that includes the right foods, herbs, and spices in the right amounts and enough avoidance of the wrong foods in too much quantity that would basically substitute for using the blood thinner coumadin? This is for someone who has had atrial fibrillation which seems to have been the cause of a transient ischemic attack which didn't do any noticeable damage after it passed.
The atrial fibrillation was about a year ago, but there are some ventricular arrythmias occasionally as well, but none progressing to a- fib at this point.

I looked up some references. A citation from Marchioli et al [1]:

"... CONCLUSIONS: The early effect of low-dose (1 g/d) n-3 PUFAs on total mortality and sudden death supports the hypothesis of an antiarrhythmic effect of this drug. Such a result is consistent with the wealth of evidence coming from laboratory experiments on isolated myocytes, animal models, and epidemiological and clinical studies."

References:

1. Marchioli R, Barzi F, Bomba E, Chieffo C, Di Gregorio D, Di Mascio R,
Franzosi MG, Geraci E, Levantesi G, Maggioni AP, Mantini L, Marfisi RM,
Mastrogiuseppe G, Mininni N, Nicolosi GL, Santini M, Schweiger C, Tavazzi L,
Tognoni G, Tucci C, Valagussa F.
Early protection against sudden death by n-3 polyunsaturated fatty acids after myocardial infarction: time-course analysis of the results of the
Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico (GISSI)-Prevenzione.
Circulation. 2002 Apr 23;105(16):1897-903.
PMID: 11997274 [PubMed - indexed for MEDLINE] http://circ.ahajournals.org/cgi/content/full/105/16/ 1897 (full text) http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=PubMed&list_uids=11997274& dopt=Abstract

2: Rosenberg IH.
Fish -- food to calm the heart.
N Engl J Med. 2002 Apr 11;346(15):1102-3. No abstract available.
PMID: 11948268 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=PubMed&list_uids=11948268& dopt=Abstract

3: Goldstein MR.
Sudden death due to cardiac arrhythmias.
N Engl J Med. 2002 Mar 21;346(12):946-7; discussion 946-7. No abstract available.
PMID: 11911139 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=PubMed&list_uids=11911139& dopt=Abstract

4: Demaison L, Moreau D.
Dietary n-3 polyunsaturated fatty acids and coronary heart disease-related mortality: a possible mechanism of action.
Cell Mol Life Sci. 2002 Mar;59(3):463-77. Review.
PMID: 11964125 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=PubMed&list_uids=11964125& dopt=Abstract

5: De Caterina R, Madonna R. [Antiarrhythmia effects of omega-3 fatty acids. A review]
Ital Heart J. 2002 Mar;3(3 Suppl):297-308. Review. Italian.
PMID: 12040845 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=PubMed&list_uids=12040845& dopt=Abstract

6: Harris WS, Isley WL.
Clinical trial evidence for the cardioprotective effects of omega-3 fatty acids.
Curr Atheroscler Rep. 2001 Mar;3(2):174-9. Review.
PMID: 11177663 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=PubMed&list_uids=11177663& dopt=Abstract

7: Leaf A.
Diet and sudden cardiac death.
J Nutr Health Aging. 2001;5(3):173-8. Review.
PMID: 11458288 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=PubMed&list_uids=11458288& dopt=Abstract

8: Leaf A.
The electrophysiologic basis for the antiarrhythmic and anticonvulsant effects of n-3 polyunsaturated fatty acids: heart and brain.
Lipids. 2001;36 Suppl107-10. Review.
PMID: 11837982 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=PubMed&list_uids=11837982& dopt=Abstract

9: McLennan PL.
Myocardial membrane fatty acids and the antiarrhythmic actions of dietary fish oil in animal models.
Lipids. 2001;36 Suppl111-4. Review.
PMID: 11837983 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=PubMed&list_uids=11837983& dopt=Abstract

10: Marchioli R, Schweiger C, Tavazzi L, Valagussa F.
Efficacy of n-3 polyunsaturated fatty acids after myocardial infarction:
results of GISSI-Prevenzione trial. Gruppo Italiano per lo Studio della
Sopravvivenza nell'Infarto Miocardico.
Lipids. 2001;36 Suppl119-26.
PMID: 11837985 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=PubMed&list_uids=11837985& dopt=Abstract

11: Franzosi MG, Brunetti M, Marchioli R, Marfisi RM, Tognoni G,
Valagussa F.
Cost-effectiveness analysis of n-3 polyunsaturated fatty acids (PUFA) after myocardial infarction: results from Gruppo Italiano per lo Studio della
Sopravvivenza nell'Infarto (GISSI)-Prevenzione Trial.
Pharmacoeconomics. 2001;19(4):411-20.
PMID: 11383757 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=PubMed&list_uids=11383757& dopt=Abstract

12: Sellmayer A, Theisen K, Weber PC. [Omega-3 fatty acids after myocardial infarct: decreasing mortality by anti-arrhythmia effects]
Dtsch Med Wochenschr. 2000 Dec 15;125(50):1542-6. Review. German. No abstract available.
PMID: 11190766 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=PubMed&list_uids=11190766& dopt=Abstract

13: Leifert WR, Jahangiri A, Saint DA, McMurchie EJ.
Effects of dietary n-3 fatty acids on contractility, Na(+) and K(+) currents in a rat cardiomyocyte model of arrhythmia.
J Nutr Biochem. 2000 Jul 1;11(7-8):382-392.
PMID: 11044633 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=PubMed&list_uids=11044633& dopt=Abstract

14: Kang JX, Leaf A.
Prevention of fatal cardiac arrhythmias by polyunsaturated fatty acids.
Am J Clin Nutr. 2000 Jan;71(1 Suppl):202S-7S. Review.
PMID: 10617972 [PubMed - indexed for MEDLINE] http://www.ajcn.org/cgi/content/full/71/1/202
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=PubMed&list_uids=10617972& dopt=Abstract

15: Siscovick DS, Raghunathan T, King I, Weinmann S, Bovbjerg VE, Kushi L,
Cobb LA, Copass MK, Psaty BM, Lemaitre R, Retzlaff B, Knopp RH.
Dietary intake of long-chain n-3 polyunsaturated fatty acids and the risk of primary cardiac arrest.
Am J Clin Nutr. 2000 Jan;71(1 Suppl):208S-12S.
PMID: 10617973 [PubMed - indexed for MEDLINE] http://www.ajcn.org/cgi/content/full/71/1/208

16: Leaf A, Kang JX, Xiao YF, Billman GE, Voskuyl RA.
The antiarrhythmic and anticonvulsant effects of dietary N-3 fatty acids.
J Membr Biol. 1999 Nov 1;172(1):1-11. Review.
PMID: 10552009 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=PubMed&list_uids=10552009& dopt=Abstract

17: Charnock JS.
Omega-3 polyunsaturated fatty acids and ventricular fibrillation: the possible involvement of eicosanoids.
Prostaglandins Leukot Essent Fatty Acids. 1999 Oct;61(4):243-7. Review.
PMID: 10574648 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=PubMed&list_uids=10574648& dopt=Abstract

18: [No authors listed]
Dietary supplementation with n-3 polyunsaturated fatty acids and vitamin E after myocardial infarction: results of the GISSI-Prevenzione trial. Gruppo
Italiano per lo Studio della Sopravvivenza nell'Infarto miocardico.
Lancet. 1999 Aug 7;354(9177):447-55.
PMID: 10465168 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=PubMed&list_uids=10465168& dopt=Abstract

19: Segal-Isaacson CJ, Wylie-Rosett J.
The cardiovascular effects of fish oils and omega-3 fatty acids.
Heart Dis. 1999 Jul-Aug;1(3):149-54. Review.
PMID: 11720618 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=PubMed&list_uids=11720618& dopt=Abstract

20: Billman GE, Kang JX, Leaf A.
Prevention of sudden cardiac death by dietary pure omega-3 polyunsaturated fatty acids in dogs.
Circulation. 1999 May 11;99(18):2452-7.
PMID: 10318669 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=PubMed&list_uids=10318669& dopt=Abstract

21: Leaf A, Kang JX, Xiao YF, Billman GE. n-3 fatty acids in the prevention of cardiac arrhythmias.
Lipids. 1999;34 Suppl187-9. Review.
PMID: 10419144 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=PubMed&list_uids=10419144& dopt=Abstract

22: Landmark K. [Fish, fish oils, arrhythmias and sudden death]
Tidsskr Nor Laegeforen. 1998 Jun 10;118(15):2328-31. Review. Norwegian.
PMID: 9691799 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=PubMed&list_uids=9691799& dopt=Abstract

23: Leaf A, Kang JX, Xiao YF, Billman GE.
Dietary n-3 fatty acids in the prevention of cardiac arrhythmias.
Curr Opin Clin Nutr Metab Care. 1998 Mar;1(2):225-8. Review.
PMID: 10565352 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=PubMed&list_uids=10565352& dopt=Abstract

24: Billman GE, Kang JX, Leaf A.
Prevention of ischemia-induced cardiac sudden death by n-3 polyunsaturated fatty acids in dogs.
Lipids. 1997 Nov;32(11):1161-8.
PMID: 9397401 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=PubMed&list_uids=9397401& dopt=Abstract

25: Connor SL, Connor WE.
Are fish oils beneficial in the prevention and treatment of coronary artery disease?
Am J Clin Nutr. 1997 Oct;66(4 Suppl):1020S-1031S. Review.
PMID: 9322583 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=PubMed&list_uids=9322583& dopt=Abstract

26: Christensen JH, Gustenhoff P, Korup E, Aaroe J, Toft E, Moller JM,
Rasmussen K, Dyerberg J, Schmidt EB. [n-3 polyunsaturated fatty acids, heart rate variability and ventricular arrhythmias in post-AMI-patients. A clinical controlled trial]
Ugeskr Laeger. 1997 Sep 8;159(37):5525-9. Danish.
PMID: 9312922 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=PubMed&list_uids=9312922& dopt=Abstract

27: Singh RB, Niaz MA, Sharma JP, Kumar R, Rastogi V, Moshiri M.
Randomized, double-blind, placebo-controlled trial of fish oil and mustard oil in patients with suspected acute myocardial infarction: the Indian experiment of infarct survival--4.
Cardiovasc Drugs Ther. 1997 Jul;11(3):485-91.
PMID: 9310278 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=PubMed&list_uids=9310278& dopt=Abstract

28: Nair SS, Leitch JW, Falconer J, Garg ML.
Prevention of cardiac arrhythmia by dietary (n-3) polyunsaturated fatty acids and their mechanism of action.
J Nutr. 1997 Mar;127(3):383-93. Review.
PMID: 9082021 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=PubMed&list_uids=9082021& dopt=Abstract

29: Leaf A, Kang JX.
Dietary n-3 fatty acids in the prevention of lethal cardiac arrhythmias.
Curr Opin Lipidol. 1997 Feb;8(1):4-6. Review.
PMID: 9127703 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=PubMed&list_uids=9127703& dopt=Abstract

30: Anderson KE, Du XJ, Sinclair AJ, Woodcock EA, Dart AM.
Dietary fish oil prevents reperfusion Ins(1,4,5)P3 release in rat heart:
possible antiarrhythmic mechanism.
Am J Physiol. 1996 Oct;271(4 Pt 2):H1483-90.
PMID: 8897943 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=PubMed&list_uids=8897943& dopt=Abstract

31: Kang JX, Leaf A.
Antiarrhythmic effects of polyunsaturated fatty acids. Recent studies.
Circulation. 1996 Oct 1;94(7):1774-80. Review. No abstract available.
PMID: 8840874 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=PubMed&list_uids=8840874& dopt=Abstract

32: Weylandt KH, Kang JX, Leaf A.
Polyunsaturated fatty acids exert antiarrhythmic actions as free acids rather than in phospholipids.
Lipids. 1996 Sep;31(9):977-82.
PMID: 8882978 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=PubMed&list_uids=8882978& dopt=Abstract

33: Leaf A, Kang JX.
Prevention of cardiac sudden death by N-3 fatty acids: a review of the evidence.
J Intern Med. 1996 Jul;240(1):5-12. Review.
PMID: 8708597 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=PubMed&list_uids=8708597& dopt=Abstract

34: Kang JX, Leaf A.
The cardiac antiarrhythmic effects of polyunsaturated fatty acid.
Lipids. 1996 Mar;31 Suppl41-4.
PMID: 8729092 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=PubMed&list_uids=8729092& dopt=Abstract

35: Pepe S, McLennan PL.
Dietary fish oil confers direct antiarrhythmic properties on the myocardium of rats.
J Nutr. 1996 Jan;126(1):34-42.
PMID: 8558320 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=PubMed&list_uids=8558320& dopt=Abstract

36: Sellmayer A, Witzgall H, Lorenz RL, Weber PC.
Effects of dietary fish oil on ventricular premature complexes.
Am J Cardiol. 1995 Nov 1;76(12):974-7.
PMID: 7484845 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=PubMed&list_uids=7484845& dopt=Abstract

37: Siscovick DS, Raghunathan TE, King I, Weinmann S, Wicklund KG, Albright
J, Bovbjerg V, Arbogast P, Smith H, Kushi LH, et al.
Dietary intake and cell membrane levels of long-chain n-3 polyunsaturated fatty acids and the risk of primary cardiac arrest.
JAMA. 1995 Nov 1;274(17):1363-7.
PMID: 7563561 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=PubMed&list_uids=7563561& dopt=Abstract

38: Kang JX, Leaf A.
Prevention and termination of beta-adrenergic agonist-induced arrhythmias by free polyunsaturated fatty acids in neonatal rat cardiac myocytes.
Biochem Biophys Res Commun. 1995 Mar 17;208(2):629-36.
PMID: 7695617 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=PubMed&list_uids=7695617& dopt=Abstract

39: Leaf A.
Omega-3 fatty acids and prevention of ventricular fibrillation.
Prostaglandins Leukot Essent Fatty Acids. 1995 Feb-Mar;52(2-3):197-8.
Review.
PMID: 7784457 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=PubMed&list_uids=7784457& dopt=Abstract

40: Isensee H, Jacob R.
Differential effects of various oil diets on the risk of cardiac arrhythmias in rats.
J Cardiovasc Risk. 1994 Dec;1(4):353-9.
PMID: 7542556 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=PubMed&list_uids=7542556& dopt=Abstract

41: Billman GE, Hallaq H, Leaf A.
Prevention of ischemia-induced ventricular fibrillation by omega 3 fatty acids.
Proc Natl Acad Sci U S A. 1994 May 10;91(10):4427-30.
PMID: 8183925 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=PubMed&list_uids=8183925& dopt=Abstract
http://www.pnas.org/cgi/reprint/91/10/4427.pdf

42: Charnock JS.
Dietary fats and cardiac arrhythmia in primates.
Nutrition. 1994 Mar-Apr;10(2):161-9. Review.
PMID: 8025371 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=PubMed&list_uids=8025371& dopt=Abstract

43: Yang B, Saldeen TG, Nichols WW, Mehta JL.
Dietary fish oil supplementation attenuates myocardial dysfunction and injury caused by global ischemia and reperfusion in isolated rat hearts.
J Nutr. 1993 Dec;123(12):2067-74.
PMID: 8263599 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=PubMed&list_uids=8263599& dopt=Abstract

44: McLennan PL, Bridle TM, Abeywardena MY, Charnock JS.
Comparative efficacy of n-3 and n-6 polyunsaturated fatty acids in modulating ventricular fibrillation threshold in marmoset monkeys.
Am J Clin Nutr. 1993 Nov;58(5):666-9.
PMID: 8237873 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=PubMed&list_uids=8237873& dopt=Abstract

45: Topping D.
Dietary fatty acids and protection against experimental cardiac arrhythmias in rats.
Nutr Rev. 1993 Sep;51(9):271-3. Review.
PMID: 8247419 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=PubMed&list_uids=8247419& dopt=Abstract

46: McLennan PL.
Relative effects of dietary saturated, monounsaturated, and polyunsaturated fatty acids on cardiac arrhythmias in rats.
Am J Clin Nutr. 1993 Feb;57(2):207-12.
PMID: 8424390 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=PubMed&list_uids=8424390& dopt=Abstract

47: McLennan PL, Bridle TM, Abeywardena MY, Charnock JS.
Dietary lipid modulation of ventricular fibrillation threshold in the marmoset monkey.
Am Heart J. 1992 Jun;123(6):1555-61.
PMID: 1595535 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=PubMed&list_uids=1595535& dopt=Abstract

48: Riemersma RA, Sargent CA.
Dietary fish oil and ischaemic arrhythmias.
J Intern Med Suppl. 1989;225(731):111-6.
PMID: 2706038 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=PubMed&list_uids=2706038& dopt=Abstract

49: McLennan PL, Abeywardena MY, Charnock JS.
Dietary fish oil prevents ventricular fibrillation following coronary artery occlusion and reperfusion.
Am Heart J. 1988 Sep;116(3):709-17.
PMID: 3414486 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=PubMed&list_uids=3414486& dopt=Abstract

I include also an excerpt from the article _Omega-3 Fatty Acids & ( http://www.foodandhealth.com/cpecourses/omega3.shtml ) by James J. Kenney, PhD, RD, FACN:

Omega 3s dramatically reduce deaths from heart attacks http://www.foodandhealth.com/cpecourses/ omega3.shtml#_Toc481486155

"Omega 3s dramatically reduce deaths from heart attacks

Omega 3s alter the production of prostaglandins in the body. Omega-3s inhibit the production of thromboxane A2 (Tx A2) and inflammatory cytokines. Both of these changes tend to reduce the tendency of blood to clot, which should the risk of a fatal heart attack.[13] However, it is unlikely that a reduction in the tendency of blood to clot is the only mechanism by which omega-3s protect against fatal heart attacks. This is because the decrease in death rate from heart attacks with a higher intake of omega-3s was similar in people who were taking aspirin as in those who were not. Since aspirin works to reduce IHD primarily by blocking the formation of Tx A2 and inflammation, one would expect that the use of aspirin would have attenuated the protective effect of omega-3s. Since the protection was just as great in those taking aspirin as those not on aspirin, the omega-3s appear to be reducing the risk of fatal heart attacks by some other mechanism.

Another likely mechanism whereby omega 3s could protect against a fatal heart attack is by reducing the risk of cardiac arrhythmias, particularly after an ischemic event. Ventricular fibrillation in patients with advanced coronary heart disease (CAD) can often result from an ischemic event and is usually fatal if not short-circuited by an electric shock to the chest. Omega 3s have been shown to have an antiarrhythmic effect in animal studies.[14] In humans, an increase in heart rate variability (HRV) following an MI is associated with a decreased risk of fatal arrhythmias.[15] Recently it was shown that supplementation of omega 3s (and particularly DHA) can increase HRV in healthy men but only in those who initially had low HRV.[16]

A 10-year follow-up of the Nurses' Health Study showed a protective effect of omega-3s against a fatal heart attack. The women who consumed the most omega-3s were found to have only about half as many fatal heart attacks compared to those who consumed the least. However, the women consuming more omega-3s were no less likely to have a nonfatal heart attack.[17] This is consistent with a secondary prevention trial in which the subjects who were advised to consume 2 or more servings of fish a week were found to have a 29% reduction in fatal MI compared to those who did not increase fish intake. As with the Nurses' Health Study, there was no decrease in the number of MI in those subjects advised to eat more fish[18].

The impact of omega 3s in stabilizing heart muscle cell membranes and perhaps in reducing clot formation appear to be the primary mechanisms by which they reduce CVD. There is growing evidence that omega-3s help to stabilize the heart muscle cell membranes during an ischemic event.
This reduces the risk of a fatal arrhythmia (ie, ventricular fibrillation) developing.[19] Because omega 3s do not appear to reduce the risk of having a heart attack (only a fatal one), it appears they may have only a modest impact on the progression of atherosclerosis."

References for this article:

[13] Owen PA. Coronary thrombosis. Its mechanism and possible prevention by linolenic acid. Ann Intern Med 1965;62:167-84

[14] Billman GE, Hallaq H, Leaf A. Prevention of ischemic-induced ventricular fibrillation by n-3 fatty acids. Proc Natl Acad Sci USA
1994;91:4427-30 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=PubMed&list_uids=8183925& dopt=Abstract

[15] Kleiger RE, Miller JP, Bigger JT, Moss AJ, et al. Decreased heart rate variability and its association with increased mortality after acute myocardial infarction. Am J Cardiol 1987;59:256-62 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=PubMed&list_uids=3812275& dopt=Abstract

[16] Christensen JH, Christensen MS, Dyerberg J, Schmidt EB. Heart rate variability and fatty acid content of blood cell membranes: a dose-response study with n-3 fatty acids. Am J Clin Nutr 1999;70:331-7 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=PubMed&list_uids=10479194& dopt=Abstract

[17] Hu FB, Stampfer MJ, Manson JE, et al. Dietary intake of linolenic acid and risk of fatal IHD among women. Am J Clin Nutr 1999;69:890-7 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=PubMed&list_uids=10232627& dopt=Abstract

[18] Burr ML, Fehily AM, Gilbert JF, et al. Effects of changes in fat, fish, and fibre intakes on death and myocardial infarction: diet and reinfarction trial (DART). Lancet 1989;2:757-61 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=PubMed&list_uids=2571009& dopt=Abstract

[19] Nair SS, Leitch JW, Falconer J, Garg ML. Prevention of cardiac arrhythmia by dietary (n-3) polyunsaturated fatty acid and their mechanism of action. J Nutr 1997;127:383-93 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=PubMed&list_uids=9082021& dopt=Abstract

Above was mentioned that increase in heart rate variability (HRV)
following an MI is associated with a decreased risk of fatal arrhythmias and that that supplementation of long chain omega 3s (and particularly
DHA) can increase HRV. The following study found that alpha-linolenic acid lacks this effect:

Christensen JH, Christensen MS, Toft E, Dyerberg J, Schmidt EB. alpha-linolenic acid and heart rate variability.
Nutr Metab Cardiovasc Dis. 2000 Apr;10(2):57-61. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=PubMed&list_uids=10919169& dopt=Abstract

"CONCLUSION: The present study was unable to demonstrate a positive correlation between cell membrane levels of alpha-linolenic acid and HRV. Our results suggest that alpha-linolenic acid per se is devoid of an antiarrhythmic effect, though this effect could arise from its conversion to the longer chained n-3 PUFA, usually derived from fish.

For info on A Fib go to
www.afibbers.net

I forgot to mention in the previous message that some polyunsaturated fatty acids, especially those found in fish oil, are anti-arrhythmic.
There are studies about this in Medline; I've dug them up in the past and can do it again, if you wish. Probably largely for this reason some clinical trials have found that fish oil reduces the risk of sudden death in cardiac patients. So if there is a risk of ventricular arrhythmias I would consider taking fish oil daily as a precautionary measure. IMHO it doesn't remove the need for anticoagulant though.

Why he wants to replace coumadin (warfarin)? There are other anticoagulants of course, but they may have their own problems, too.
I've been prescribed low molecular weight heparin (Fragmin) as precautionary measure before and after surgical operations, but it has to be delivered by subcutaneous injection. Aspirin is also an anticoagulant, but it probably (?) has not been proven in your friend's condition. There may be some studies (or a study) comparing warfarin and aspirin for some condition, perhaps someone could try to look them up from Medline. If not, maybe I'll try to do that tomorrow.

As for herbs or diet, it's true that they can slightly affect coagulation, but probably not enough.

let me put you a couple of questions that are not at all trivial for me.

1) can a person have a vagal paroxysmal afib and not be at risk?

2) and if so, the next time I see my cardiologist should I better ask him if I am at risk, or not? (shame on me, I've never asked him this question in almost ten years)

thanks so much and best regards

I am a cardiology technician and work for an electrophysiologist. His opinion as a rhythm specialist is that atrial fibrillation lasting longer than 15 minutes is significant.I have long been told that flipping up and back from sinus rhythm to atrial fibrillation also increases stoke risk. There is no substitution for coumadin. Aspirin therapy has show to be effective in preventing heart attacks by affecting platelet aggregation. Plavix is a great drug for those this clots in the legs etc. It makes the platelets slippery I believe. These substance do not protect the patient from embolic stroke. Why would you want to chance a person you care for. Life isnt easy. Aging is not easy. Sometimes we need to do weather the storm and do the hard thing to achieve our goal even if it is not umpleasant. In this case the goal is continued health.

My paroxysmal afib was diagnosed in 1995 and I am on warfarin since then. I had a dual-chamber pacemaker implanted mid 2002 because of extreme bradycardia and AV block 1st degree. No other heart problem, thanks God.

Upon my last PM check last summer, my cardiologist said that I'd better quit warfarin because my (quite frequent) afib episodes were lasting from few minutes to few hours only. He explained that, considering the pro's and con's of warfarin, that drug should be taken only in case of afibs lasting more than 24-48 hours (I do not remember if he said 24 or 48 or both).
Anyway, my cardiologist preferred to defer his final recommendation (about quitting warfarin) to my next PM check which is due in december.

I would appreciate your comment about warfarin therapy and the duration of paroxysmal afib episodes, please.

Matti Narkia <snip>

Below some newer references:

1: Hirafuji M, Machida T, Hamaue N, Minami M. Cardiovascular protective effects of n-3 polyunsaturated fatty acids with special emphasis on docosahexaenoic acid.
J Pharmacol Sci. 2003 Aug;92(4):308-16.
PMID: 12939515 [PubMed - in process] <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&amp;db=PubMed&amp;list_uids=12939515&amp; dopt=Abstract>

2: Richter WO. Long-chain omega-3 fatty acids from fish reduce sudden cardiac death in patients with coronary heart disease.
Eur J Med Res. 2003 Aug 20;8(8):332-6.
PMID: 12915328 [PubMed - in process] <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&amp;db=PubMed&amp;list_uids=12915328&amp; dopt=Abstract>

3: Dallongeville J, Yarnell J, Ducimetiere P, Arveiler D, Ferrieres J,
M, Luc G, Evans A, Bingham A, Hass B, Ruidavets JB, Amouyel P. Fish consumption is associated with lower heart rates.
Circulation. 2003 Aug 19;108(7):820-5. Epub 2003 Aug 11.
PMID: 12912821 [PubMed - indexed for MEDLINE] <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&amp;db=PubMed&amp;list_uids=12912821&amp; dopt=Abstract>

4: Lee KW, Lip GY. The role of omega-3 fatty acids in the secondary prevention of cardiovascular disease.
QJM. 2003 Jul;96(7):465-80. Review.
PMID: 12881589 [PubMed - indexed for MEDLINE] <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&amp;db=PubMed&amp;list_uids=12881589&amp; dopt=Abstract>

5: Mozaffarian D, Lemaitre RN, Kuller LH, Burke GL, Tracy RP, Siscovick DS;
Cardiovascular Health Study. Cardiac benefits of fish consumption may depend on the type of fish meal consumed: the Cardiovascular Health Study.
Circulation. 2003 Mar 18;107(10):1372-7.
PMID: 12642356 [PubMed - indexed for MEDLINE] <http://circ.ahajournals.org/cgi/content/full/107/10/ 1372> (full text)
<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&amp;db=PubMed&amp;list_uids=12642356&amp; dopt=Abstract>

6: Carroll DN, Roth MT. Evidence for the cardioprotective effects of omega-3 Fatty acids.
Ann Pharmacother. 2002 Dec;36(12):1950-6.
PMID: 12452760 [PubMed - indexed for MEDLINE] <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&amp;db=PubMed&amp;list_uids=12452760&amp; dopt=Abstract>

7: Albert CM, Campos H, Stampfer MJ, Ridker PM, Manson JE, Willett WC,
Ma J. Blood levels of long-chain n-3 fatty acids and the risk of sudden death.
N Engl J Med. 2002 Apr 11;346(15):1113-8.
PMID: 11948270 [PubMed - indexed for MEDLINE] <http://content.nejm.org/cgi/content/full/346/15/1113> (full text)

The next TIA may very well be a full blown stroke without coumadin anticoagulation.

Well, I couldn't resist poking Medline. Warfarin (Coumadin) is usually recommended for atrial fibrillation and most comparison trials seem to have found it at least slightly more effective than aspirin. But there seems to be also conflicting opinions, see Mooe's article [2] below.
Most studies conclude that aspirin could be used for low risk patients, or patients who cannot or don't want to take warfarin.

1: Hylek EM, Go AS, Chang Y, Jensvold NG, Henault LE, Selby JV, Singer
DE. Effect of intensity of oral anticoagulation on stroke severity and mortality in atrial fibrillation.
N Engl J Med. 2003 Sep 11;349(11):1019-26.
PMID: 12968085 [PubMed - indexed for MEDLINE] <http://content.nejm.org/cgi/content/full/349/11/1019> <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&amp;db=PubMed&amp;list_uids=12968085&amp; dopt=Abstract>

2: Mooe T. [Choice of antithrombotic therapy in atrial fibrillation, a daily challenge. No convincing evidence that warfarin is better than acetylsalicylic acid]
Lakartidningen. 2003 Aug 21;100(34):2597-9, 2602-4. Review. Swedish.
PMID: 12968319 [PubMed - indexed for MEDLINE] <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&amp;db=PubMed&amp;list_uids=12968319&amp; dopt=Abstract>

3: Connolly SJ. Preventing stroke in patients with atrial fibrillation: current treatments and new concepts.
Am Heart J. 2003 Mar;145(3):418-23. Review.
PMID: 12660663 [PubMed - indexed for MEDLINE] <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&amp;db=PubMed&amp;list_uids=12660663&amp; dopt=Abstract>

4: Taylor FC, Cohen H, Ebrahim S. Systematic review of long term anticoagulation or antiplatelet treatment in patients with non-rheumatic atrial fibrillation.
BMJ. 2001 Feb 10;322(7282):321-6. Erratum in: BMJ 2001 Mar
10;322(7286):587.
PMID: 11159653 [PubMed - indexed for MEDLINE] <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&amp;db=PubMed&amp;list_uids=11159653&amp; dopt=Abstract>

5: Koudstaal PJ. Anticoagulants versus antiplatelet therapy for preventing stroke in patients with nonrheumatic atrial fibrillation and a history of stroke or transient ischemic attacks.
Cochrane Database Syst Rev. 2000;(2):CD000187. Review.
PMID: 10796315 [PubMed - indexed for MEDLINE] <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&amp;db=PubMed&amp;list_uids=10796315&amp; dopt=Abstract>

6: Segal JB, McNamara RL, Miller MR, Kim N, Goodman SN, Powe NR,
Robinson KA, Bass EB. Prevention of thromboembolism in atrial fibrillation. A meta-analysis of trials of anticoagulants and antiplatelet drugs.
J Gen Intern Med. 2000 Jan;15(1):56-67.
PMID: 10632835 [PubMed - indexed for MEDLINE] <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&amp;db=PubMed&amp;list_uids=10632835&amp; dopt=Abstract>

7: Howard PA. Guidelines for stroke prevention in patients with atrial fibrillation.
Drugs. 1999 Dec;58(6):997-1009. Review.
PMID: 10651387 [PubMed - indexed for MEDLINE] <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&amp;db=PubMed&amp;list_uids=10651387&amp; dopt=Abstract>

8: Hart RG, Benavente O, McBride R, Pearce LA. Antithrombotic therapy to prevent stroke in patients with atrial fibrillation: a meta-analysis.
Ann Intern Med. 1999 Oct 5;131(7):492-501.
PMID: 10507957 [PubMed - indexed for MEDLINE] <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&amp;db=PubMed&amp;list_uids=10507957&amp; dopt=Abstract>

9: Posada IS, Barriales V. Alternate-day dosing of aspirin in atrial fibrillation. LASAF Pilot
Study Group.
Am Heart J. 1999 Jul;138(1 Pt 1):137-43.
PMID: 10385777 [PubMed - indexed for MEDLINE] <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&amp;db=PubMed&amp;list_uids=10385777&amp; dopt=Abstract>

10: [No authors listed] The efficacy of aspirin in patients with atrial fibrillation. Analysis of pooled data from 3 randomized trials. The Atrial Fibrillation
Investigators.
Arch Intern Med. 1997 Jun 9;157(11):1237-40.
PMID: 9183235 [PubMed - indexed for MEDLINE] <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&amp;db=PubMed&amp;list_uids=9183235&amp; dopt=Abstract>

I will be very interested in the response you get to this posting. I will be on Warfarin for the rest of my life because I have a mechanical MV. Also, like you, and with a dual chamber pacemaker I have paroxysmal AF and atrial flutter and first degress heart block.
For me, warfarin does not seem to be such a major thing except that, at the moment, there is a problem trying to regulate my INR. This has only occurred since my pacemaker was inserted but I cannot see how it can be the cause. I take 3000 mgs of Omega 3 fish oil each day (with the clinic's approval) but my INR seems to be sticking at 2.8 when they want it to be between 3-4. Re Aspirin - is there not a danger of stomach problems with it? Also, agree with other posters that AF should not be treated lightly. Even if there is no valve damage the electric fault is there and should be taken seriously. Diana

Big gamble you take with that kind of experimentation. If you are wrong, death or a stroke could be the result. I just take the
Warfarin.