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Prophylactic Colchicine After Ablation of Atrial Fibrillation
Quick Takes
- Among 139 patients randomized to post-AF ablation colchicine vs. standard of care, there was no difference in the incidence of clinical pericarditis at 14 days, with the rate of pericarditis about 10% in both groups.
- The rate of gastrointestinal discomfort with colchicine treatment was 47% vs. 15% in the standard of care group.
Study Questions:
Does a prophylactic colchicine treatment after atrial fibrillation (AF) ablation reduce the incidence and severity of postoperative pericarditis?
Methods:
The authors conducted PAPERS (Post-Ablation PEricarditis Reduction Study), a two-center, prospective, randomized controlled trial of no post-procedure colchicine versus 7 days of colchicine 0.6 mg oral twice daily starting immediately post-procedure. Patients were surveyed at 14 days after ablation.
Results:
Among 139 patients enrolled, 66 were randomized to no colchicine (group A), and 73 patients to colchicine (group B). Clinical pericarditis occurred in 10.6% of patients in group A and 9.6% of patients in group B (p = 0.84). The rate of gastrointestinal discomfort in group A was 15% and 47% in group B (p < 0.001). Patients who also underwent cavotricuspid isthmus ablation experienced higher rates of pericarditis.
Conclusions:
The authors found that prophylactic colchicine after AF ablation did not affect the incidence of post-ablation pericarditis and was associated with a significantly increased incidence of gastrointestinal side effects.
Perspective:
Post-AF ablation pericarditis is a relatively common side effect of the procedure, and it is associated with increased costs and burden of follow-up. Some prior studies have examined the role of colchicine on AF recurrence after endocardial ablation procedures, and at least one showed lower incidence of AF with the periprocedural use of the drug. The results of the present trial suggest that prophylactic colchicine does not reduce the incidence of ‘clinical pericarditis,’ i.e., a diagnosis arrived at without standardized use of echocardiography or electrocardiography. This was also not a placebo-controlled trial, though this would be expected to bias the findings in the opposite direction. The gastrointestinal side effects occurred in one out of two patients on the drug.
Clinical Topics: Arrhythmias and Clinical EP, Cardiovascular Care Team, Heart Failure and Cardiomyopathies, Pericardial Disease, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure
Keywords: Ablation Techniques, Arrhythmias, Cardiac, Atrial Fibrillation, Colchicine, Gastrointestinal Tract, Heart Failure, Pericarditis, Postoperative Period, Radiofrequency Ablation
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