Given the suggestion that oxidative stress may potentiate AF, several investigators have evaluated the prophylactic administration of omega-3 fatty acids and antioxidant vitamins to reduce its incidence after CABG. Meta-analyses on this subject have presented conflicting data, suggesting a potential for vitamins and omega-3 fatty acids to reduce the risk of perioperative AF, but the results are inconsistent, with a lack of high-quality data in the literature.432 434 Therefore, the available evidence to date remains insufficient, and additional large-scale, adequately powered clinical studies are warranted before routine admin- istration of antioxidant vitamins can be recommended for the reduction of AF after CABG. Vitamins and Supplements Recommendations 1. Vitamin supplementation in patients with specific vitamin deficiencies may be considered for patients undergoing CABG, but the effectiveness is not well established (Class IIb; Level of Evidence C). 2. Supplementation with omega-3 fatty acids and anti- oxidant vitamins may be considered to prevent post- operative AF after CABG, but additional clinical Kulik et al Secondary Prevention After CABG 949 studies are warranted before routine use of antioxi- dant vitamins can be recommended (Class IIb; Level of Evidence A). 