Colchicine Reduces Postoperative Atrial Fibrillation: Results of the Colchicine for the Prevention of Postpericardiotomy Syndrome (COPPS) Atrial Fibrillation Substudy

Study Questions:

Does colchicine prevent postoperative atrial fibrillation (POAF) after cardiac surgery?

Methods:

In the COPPS (Colchicine for the Prevention of Postpericardiotomy Syndrome) Atrial Fibrillation Substudy, a double-blind trial, 336 patients (mean age 65 years) who underwent cardiac surgery were randomly assigned to receive colchicine (n = 169) or placebo (n = 167) starting on postoperative day 3. The colchicine dose was 1 mg twice daily for 1 day, then 0.25 or 0.5 mg twice daily depending on body weight, for 1 month. The primary endpoint was the 1-month incidence of POAF, starting on postoperative day 3.

Results:

The overall incidence of POAF was 28%, with approximately half of the episodes occurring in the first 2 postoperative days. The primary endpoint was significantly less prevalent in the colchicine group (12%) than in the placebo group (22%). The mean duration of hospitalization was significantly shorter in the colchicine group (9.4 days) than in the placebo group (10.3 days). There was no significant difference between the colchicine and placebo groups in the incidence of side effects (9.5% vs. 4.8%, respectively) or drug withdrawal (11.8% vs. 6.6%, respectively).

Conclusions:

The authors concluded that colchicine significantly reduces the risk of POAF after cardiac surgery.

Perspective:

A primary mechanism of POAF after cardiac surgery is inflammation, and colchicine has an anti-inflammatory effect. It joins a growing list of agents that are not traditional antiarrhythmic drugs, but nevertheless prevent POAF, most likely primarily through an anti-inflammatory action. These agents include hydrocortisone, statins, and long-chain polyunsaturated fatty acids (fish oil). A major limitation of the colchicine regimen tested in this study is that it does not address the nearly 50% of episodes of POAF that occur during the first 2 days after cardiac surgery.

Clinical Topics: Arrhythmias and Clinical EP, Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Pericardial Disease, Cardiac Surgery and Arrhythmias

Keywords: Inflammation, Incidence, Pericardiectomy, Body Weight, Substance Withdrawal Syndrome, Postpericardiotomy Syndrome, Thoracic Surgery, Postoperative Period


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