Colchicine for Prevention of Early Atrial Fibrillation Recurrence After Pulmonary Vein Isolation: A Randomized Controlled Study

Study Questions:

Does colchicine prevent recurrences of atrial fibrillation (AF) during the first 3 months after radiofrequency catheter ablation (RFCA) of paroxysmal AF?

Methods:

One hundred sixty-one patients (mean age 62 years) who underwent RFCA of paroxysmal AF were randomly assigned in double-blind fashion to treatment with colchicine, 0.5 mg twice daily (n = 81) or placebo (n = 80). All patients underwent pulmonary vein isolation (PVI) and 52% also underwent ablation of complex fractionated atrial electrograms. C-reactive protein (CRP) and interleukin (IL)-6 levels were measured on days 1 and 4 of treatment. No patient received an antiarrhythmic drug post-ablation. A 48-hour Holter monitor was performed every 2 weeks for 3 months. The primary endpoint was a recurrence of AF during the first 3 months post-ablation.

Results:

The AF recurrence rate was significantly lower in the colchicine group (16%) than in the placebo group (34%). There were no significant differences in CRP or IL-6 levels between the two groups on day 1. The decrease in CRP and IL-6 levels on day 4 were significantly greater in magnitude in the colchicine group. The main side effect was diarrhea (prevalence 8.6% in the colchicine group vs. 1.3% in the placebo group).

Conclusions:

The authors concluded that colchicine prevents early AF recurrences after RFCA of paroxysmal AF without serious adverse effects.

Perspective:

Inflammatory biomarkers increase after RFCA of AF and correlate with early recurrences of AF, as is the case in patients who develop AF after open heart surgery. Colchicine has been shown to prevent postoperative AF, presumably because of its anti-inflammatory effects, and this study demonstrates the same type of effect in the first 3 months after RFCA of AF.

Clinical Topics: Arrhythmias and Clinical EP, Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Cardiac Surgery and Arrhythmias

Keywords: Colchicine, Drug-Related Side Effects and Adverse Reactions, Interleukin-6, Pulmonary Veins, Diarrhea, Electrophysiologic Techniques, Cardiac, Electrocardiography, Postoperative Period, Prevalence, Recurrence, C-Reactive Protein, Biological Markers, Atrial Fibrillation, Octamer Transcription Factor-3, Cardiac Surgical Procedures, Catheter Ablation


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