Response to Letter Regarding Article, “Colchicine Reduces Postoperative Atrial Fibrillation: Results of the Colchicine for the Prevention of the Postpericardiotomy Syndrome (COPPS) Atrial Fibrillation Substudy”

Effect of ColchiciNe on the InciDence of Atrial Fibrillation in Open Heart Surgery Patients: END-AF Trial

“…In the COPPS trial of 360 cardiac surgery patients, colchicine compared to placebo reduced the incidence of postoperative AF from 22% to 12%, relative risk reduction 45% (p=0.021). It should be noted, however, that colchicine was started on the third postoperative day and that 43.3% of all episodes occurred on postoperative days 1 and 2; i.e., before randomization (16). The positive results of COPPS prompted the same group to launch COPPS-2, a trial of colchicine administered 48 and 72 hours before surgery and continued for one month after surgery.…”

“…Colchicine has potent antiinflammatory properties, including inhibition of neutrophil motility and activity and may therefore be capable of reducing the incidence of AF. It has been studied in such patients with conflicting results (16,17). It has also been shown to be effective in the prevention of early AF recurrences after pulmonary vein isolation in patients with paroxysmal AF (18,19).…”

Cardiorespiratory Fitness as a Prognostic Factor in Heart Failure Needs to be Standardized for Body Composition

“…Krachler et al astutely point out that our measure of fitness relies on adjustment by total body weight, which may underestimate fitness levels; adjustment for lean body mass rather than total body weight has been shown to be a better predictor of outcomes in heart failure. 2 We do not have measurements of body composition such as skin fold thickness or dual x-ray absorptiometry recorded in our heart failure cohort and, thus, are happy to learn of the article by Krachler et al, which outlines a method for estimating lean mass based on weight, height, and gender. 3 We hope to use this method in future studies of obesity, cardiorespiratory fitness, and outcomes in patients with heart failure.…”

“…3e5 The bias introduced by ignoring body composition in the assessment of cardiorespiratory fitness may be substantial. 2 In the absence of direct measurements of lean mass, simple estimates based on weight, height, age, and gender are a fair substitute. 6 We would therefore invite the investigators to use anthropometrics-based estimates of lean mass to standardize PKVO 2 for body composition.…”

“…Previous 2 large randomized controlled trials (COPPS and COPPS-2) have demonstrated contrasting results on the efficacy of colchicine in prevention of POAF in patients undergoing cardiothoracic surgery. 2,3 This leaves us with a question of whether colchicine may reliably prevent POAF in patients undergoing cardiac surgery. One may however speculate the reason for the observed differences in the findings of the previous trials.…”