Colchicine Reduces Postoperative Atrial Fibrillation

Abstract

MD; for the COPPS InvestigatorsBackground-Inflammation and pericarditis may be contributing factors for postoperative atrial fibrillation (POAF), and both are potentially affected by antiinflammatory drugs and colchicine, which has been shown to be safe and efficacious for the prevention of pericarditis and the postpericardiotomy syndrome (PPS). The aim of the Colchicine for the Prevention of the Post-Pericardiotomy Syndrome (COPPS) POAF substudy was to test the efficacy and safety of colchicine for the prevention of POAF after cardiac surgery. Methods and Results-The COPPS POAF substudy included 336 patients (mean age, 65.7Ϯ12.3 years; 69% male) of the COPPS trial, a multicenter, double-blind, randomized trial. Substudy patients were in sinus rhythm before starting the intervention (placebo/colchicine 1.0 mg twice daily starting on postoperative day 3 followed by a maintenance dose of 0.5 mg twice daily for 1 month in patients Ն70 kg, halved doses for patients Ͻ70 kg or intolerant to the highest dose). The substudy primary end point was the incidence of POAF on intervention at 1 month. Despite well-balanced baseline characteristics, patients on colchicine had a reduced incidence of POAF (12.0% versus 22.0%, respectively; Pϭ0.021; relative risk reduction, 45%; number needed to treat, 11) with a shorter in-hospital stay (9.4Ϯ3.7 versus 10.3Ϯ4.3 days; Pϭ0.040) and rehabilitation stay (12.1Ϯ6.1 versus 13.9Ϯ6.5 days; Pϭ0.009). Side effects were similar in the study groups. Key Words: atrial fibrillation Ⅲ cardiac surgery Ⅲ colchicine Ⅲ postpericardiotomy syndrome Ⅲ prevention P ostoperative atrial fibrillation (POAF) is the most common complication after cardiac surgery; it is reported in 10% to 65% of cases, depending on the surgery type (coronary artery bypass graft surgery, valve surgery, or combined coronary artery bypass graft/valve surgery), patient features, definition of arrhythmia, and surveillance. 1 Nowadays, POAF is becoming more common because of the increasing number of cardiac surgery operations and the aging of the population. This complication increases patient morbidity, length of hospital stay, and management costs. 2 Conclusion-Colchicine Editorial see p 2281 Clinical Perspective on p 2295Prevention of POAF is an important management goal supported by American and European guidelines. 3-5 Many different agents have been studied to fit this goal and may be grouped into 2 main categories: agents with antiarrhythmic properties and agents with antiinflammatory activity such as corticosteroids, statins, and free radical scavengers. 6 The development of POAF is likely multifactorial. Pericardial inflammation, autonomic imbalance during the postoperative time, excessive production of catecholamines, and fluid shift may all contribute. 7,8 Inflammation, inhomogeneity of atrial conduction, and the incidence of POAF are significantly decreased by corticosteroids. 9 Thus, antiinflammatory therapy may be beneficial for the prevention of POAF. In the Colchicine for the Prevention of the Postpericardiotomy ...

Resumen de los ensayos clínicos presentados en las Sesiones Científicas Anuales de la American Heart Association (Orlando, Estados Unidos, 12-16 de noviembre de 2011)

“…COPPS Atrial Fibrillation: colchicina reduce la fibrilación auricular postoperatoria 20 Presentado por: Massimo Imazio, Turín, Italia.…”

Status of Antiarrhythmic Drug Development for Atrial Fibrillation

“…Colchicine is thought to act through inhibition of microtubule assembly in cells of the immune system, particularly neutrophils, leading to inhibition of several cellular functions, including cytokine production by these cells. 63 Its method of action includes modulation of chemokine and prostanoid production and inhibition of neutrophil and endothelial cell adhesion molecules. 64 In a double-blind, placebo-controlled study, patients with paroxysmal AF who received radiofrequency ablation treatment were randomized to a 3-month course of colchicine 0.5 mg twice daily or placebo.…”

Beyond Gout: Colchicine Use in the Cardiovascular Patient

“…3 The burden of POAF is expected to increase with the escalating number of cardiac surgeries being performed in an aging population. 4 Although often considered a self-limiting complication, POAF is associated with significant morbidity, including stroke, myocardial infarction, ventricular arrhythmias, renal failure, congestive heart failure, and prolonged hospitalization. 5 The incidence of POAF is higher after valve surgery (40%) than coronary artery bypass graft (CABG) surgery (30%), and this risk escalates further with combined procedures (50%).…”

“…Pericardial inflammation, excess catecholamine production, and volume and pressure changes are all thought to alter atrial refractoriness, thereby providing a substrate for atrial fibrillation (AF) in the presence of a trigger (eg, an electrolyte imbalance or atrial premature contraction). [3][4][5] Similarly, the postpericardiotomy syndrome (PPS) occurs in 10% to 40% of patients 1 week to several months following cardiac surgery. 7,8 Although a standardized definition and universal diagnostic criteria are lacking, this immune-mediated syndrome is characterized by the presence of 2 or more of the following signs or symptoms: noninfectious fever lasting beyond the first postoperative week, pleuritic chest pain, friction rub, pleural effusion, or new/worsening pericardial effusion.…”