Prophylactic Colchicine After Radiofrequency Ablation of Atrial Fibrillation

Ahmed, Asim S.; Miller, Jennifer; Foreman, Jason; Golden, Keith; Shah, Ankur; Field, Justin; Gilge, Jasen L.; Clark, Bradley C.; Joshi, Sandeep; Nair, Girish M.; Olson, Jeffrey J.; Padanilam, Benzy J.; Prystowsky, Eric N.; Patel, Parin J.

doi:10.1016/j.jacep.2023.02.003

Cited by 15 publications

(7 citation statements)

References 9 publications

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“…[31][32][33][34][35][36] One clinical trial did not demonstrate decreased infarct size with colchicine in ACS using cardiac magnetic resonance imaging, but colchicine showed no effect on neutrophil count at 24 hours and only a trend toward lower hsCRP levels at 24 hours. 37 Several trials have evaluated the effect of colchicine on the risk of postpericardiotomy syndrome [38][39][40][41][42] and atrial fibrillation [43][44][45] after cardiac surgery and atrial fibrillation ablation. The role of colchicine after cardiac procedures remains under investigation.…”

Section: Other Cardiovascular Conditionsmentioning

confidence: 99%

Colchicine’s Role in Cardiovascular Disease Management

Buckley,

Libby

2024

ATVB

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Colchicine—an anti-inflammatory alkaloid—has assumed an important role in the management of cardiovascular inflammation ≈3500 years after its first medicinal use in ancient Egypt. Primarily used in extremely high doses for the treatment of acute gout flares during the 20th century, research in the early 21st century demonstrated that low-dose colchicine effectively treats acute gout attacks, lowers the risk of recurrent pericarditis, and can even add to secondary prevention of major adverse cardiovascular events. As the first Food and Drug Administration–approved targeted anti-inflammatory cardiovascular therapy, colchicine currently has a unique role in the management of atherosclerotic cardiovascular disease. The safe use of colchicine requires careful monitoring for drug-drug interactions, changes in kidney and liver function, and counseling regarding gastrointestinal upset. Future research should elucidate the mechanisms of anti-inflammatory effects of colchicine relevant to atherosclerosis, the potential role of colchicine in primary prevention, in other cardiometabolic conditions, colchicine’s safety in cardiovascular patients, and opportunities for individualizing colchicine therapy using clinical and molecular diagnostics.

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Section: Other Cardiovascular Conditionsmentioning

confidence: 99%

Colchicine’s Role in Cardiovascular Disease Management

Buckley,

Libby

2024

ATVB

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“…Another recent, open-label trial did not find a reduction in pericarditis with colchicine 0.6 mg twice daily administered for 7 days following catheter ablation. 25 However, periablation use of colchicine was associated with a reduction in pericarditis in a recent observational study. 26 Although gastrointestinal side effects are relatively common with colchicine, the increase in diarrhea with the 10-day treatment was substantial and clinically significant.…”

Section: Discussionmentioning

confidence: 96%

“…Our findings are consistent with a reported 3-fold increase in gastrointestinal upset in a recently published open-label trial testing colchicine 0.6 mg twice daily for 7 days following catheter ablation. 25…”

Section: Discussionmentioning

confidence: 99%

Colchicine to Prevent Atrial Fibrillation Recurrence After Catheter Ablation: A Randomized, Placebo-Controlled Trial

Benz,

Amit,

Connolly

et al. 2024

Circ: Arrhythmia and Electrophysiology

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BACKGROUND: Inflammation may promote atrial fibrillation (AF) recurrence after catheter ablation. This study aimed to evaluate a short-term anti-inflammatory treatment with colchicine following ablation of AF. METHODS: Patients scheduled for ablation were randomized to receive colchicine 0.6 mg twice daily or placebo for 10 days. The first dose of the study drug was administered within 4 hours before ablation. Atrial arrhythmia recurrence was defined as AF, atrial flutter, or atrial tachycardia >30 s on two 14-day Holters performed immediately and at 3 months following ablation. RESULTS: The modified intention-to-treat population included 199 patients (median age, 61 years; 22% female; 70% first procedure) who underwent radiofrequency (79%) or cryoballoon ablation (21%) of AF. Antiarrhythmic drugs were prescribed at discharge in 149 (75%) patients. Colchicine did not prevent atrial arrhythmia recurrence at 2 weeks (31% versus 32%; hazard ratio [HR], 0.98 [95% CI, 0.59–1.61]; P =0.92) or at 3 months following ablation (14% versus 15%; HR, 0.95 [95% CI, 0.45–2.02]; P =0.89). Postablation chest pain consistent with pericarditis was reduced with colchicine (4% versus 15%; HR, 0.26 [95% CI, 0.09–0.77]; P =0.02) and colchicine increased diarrhea (26% versus 7%; HR, 4.74 [95% CI, 1.95–11.53]; P <0.001). During a median follow-up of 1.3 years, colchicine did not reduce a composite of emergency department visit, cardiovascular hospitalization, cardioversion, or repeat ablation (29 versus 25 per 100 patient-years; HR, 1.18 [95% CI, 0.69–1.99]; P =0.55). CONCLUSIONS: Colchicine administered for 10 days following catheter ablation did not reduce atrial arrhythmia recurrence or AF-associated clinical events, but did reduce postablation chest pain and increased diarrhea.

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“…Agarwal et al reported that 0.6mg colchicine twice daily was associated with reduction of AF recurrence at 12 months 19 . In the Post Ablation Pericarditis Reduction Study (PAPERS ) trial 20 , patients were randomized on the day of the procedure to receive 0.6 mg of colchicine twice daily for 7 days. Significant side effects were reported in the treatment group (47%) with no difference in pericarditis rates.…”

Section: Discussionmentioning

confidence: 99%

Effect of Low Dose Colchicine on Long term Recurrence After Atrial Fibrillation Ablation

Al‐Sadawi

Aslam

Henriques

et al. 2023

Preprint

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Background: Colchicine is commonly used early after atrial fibrillation (AF) ablation to reduce inflammation and reduce AF recurrence, but there is limited long-term efficacy data. Objective: To evaluate the effect of low dose colchicine use on long-term AF recurrence after AF ablation. Methods: From 2013 to 2021, all AF ablations performed at a single tertiary care medical center were analyzed for colchicine use, clinical and procedural characteristics, and AF recurrence. The colchicine dose was 0.3-0.6 mg once daily for 30 days. The primary outcome was AF recurrence, defined as AF detection for more than 30 seconds after a three-month blanking period. Propensity score matching (PSM, 1:1 match) was performed using covariates that were significant predictors of AF recurrence in prior studies. The minimum duration of follow-up was 6 months. Kaplan-Meier analysis was conducted to assess time to AF recurrence in the entire cohort and the PSM cohort. Results: The study population consisted of 1568 AF ablations in 1412 patients (67% male, age 65 ± 7 years and mean follow up 34 ± 14 months); 78% of the patients received colchicine. Colchicine use was associated with decreased AF recurrence (HR 0.78, CI 0.63-0.96, p=0.022). After PSM there were 275 patients in each group. AF recurrence was lower with colchicine (HR 0.71, CI 0.53-0.96, p=0.026). Conclusions: Low dose colchicine use was associated with lower long-term AF recurrence after AF ablation. A randomized, placebo-controlled trial is warranted to confirm if low dose colchicine should be used routinely after AF ablation.

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Prophylactic Colchicine After Radiofrequency Ablation of Atrial Fibrillation

Cited by 15 publications

References 9 publications

Colchicine’s Role in Cardiovascular Disease Management

Colchicine’s Role in Cardiovascular Disease Management

Colchicine to Prevent Atrial Fibrillation Recurrence After Catheter Ablation: A Randomized, Placebo-Controlled Trial

Effect of Low Dose Colchicine on Long term Recurrence After Atrial Fibrillation Ablation

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