Impact of Colchicine Monotherapy on the Risk of Acute Pericarditis Following Atrial Fibrillation Ablation

Effect of low dose colchicine on long term recurrence after atrial fibrillation ablation

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 s 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.

Inflammation pathways as therapeutic targets in angiotensin II induced atrial fibrillation

Atrial fibrillation (AF), a common cardiac arrhythmia, is associated with severe complications such as stroke and heart failure. Although the precise mechanisms underlying AF remain elusive, inflammation is acknowledged as a pivotal factor in its progression. Angiotensin II (AngII) is implicated in promoting atrial remodeling and inflammation. However, the exact pathways through which AngII exacerbates AF are still not fully defined. This study explores the key molecular mechanisms involved, including dysregulation of calcium ions, altered connexin expression, and activation of signaling pathways such as TGF-β, PI3K/AKT, MAPK, NF-κB/NLRP3, and Rac1/JAK/STAT3. These pathways are instrumental in contributing to atrial fibrosis, electrical remodeling, and increased susceptibility to AF. Ang II-induced inflammation disrupts ion channel function, resulting in structural and electrical remodeling of the atria and significantly elevating the risk of AF. Anti-inflammatory treatments such as RAAS inhibitors, colchicine, and statins have demonstrated potential in reducing the incidence of AF, although clinical outcomes are inconsistent. This manuscript underscores the link between AngII-induced inflammation and the development of AF, proposing the importance of targeting inflammation in the management of AF.

[Colchicine-Phoenix from the ashes]

Colchicine is an anti-inflammatory herbal medicine with a history stretching back thousands of years. It is a cornerstone in the acute and prophylactic treatment of gout and has secured a permanent place in the standard pharmacological repertoire for familial Mediterranean fever, pericarditis, neutrophilic dermatoses, Behçet's disease and severe aphthous ulcers refractory to oral treatment. The US Food and Drug Administration (FDA) has recently approved colchicine to reduce the risk of myocardial infarction, stroke, coronary revascularization and cardiovascular death in adult patients with established atherosclerotic disease or with multiple risk factors for cardiovascular diseases. The recommendation level for cardiovascular prophylaxis was raised from IIb to IIa in the current European Society of Cardiology (ESC) guidelines from 2024. Clinical studies in recent years also demonstrated an effect for acute coronary syndrome and atrial fibrillation. This review article highlights the efficacy and safety profile of colchicine and provides insights into recent and potential future evidence-based fields of application.

Exploring Inflammatory Markers and Risk Factors Associated with Pericarditis Development after Ablation for Atrial Fibrillation

Background: This study aimed to explore the association between inflammatory markers and the occurrence of post-atrial fibrillation (AF) ablation pericarditis (PAP), while also examining the PAP's incidence and contributing factors. Methods: A retrospective cohort study was conducted between January 2021 and November 2023, including patients who underwent successful AF ablation. Inflammatory markers of interest included the systemic immune-inflammation index (SII), the neutrophil-to-lymphocyte ratio (NLR), and the platelet-to-lymphocyte ratio (PLR). Results: Among the 231 patients examined, 22 (9.52%) were classified as suspected PAP, and 14 (6.06%) as definitive PAP. The median age was 58 years, with no age difference between groups. Males comprised 51.52% of the sample, with male sex frequency significantly higher in the suspected PAP group relative to the other groups (p = 0.007). Multivariable logistic regression indicated that AF duration (p = 0.026) and cavotricuspid isthmus (CTI) ablation (p = 0.001) were associated with definitive PAP, whereas analysis for any pericarditis (suspected or definitive PAP) revealed independent relationships with CTI ablation (p = 0.003) and sleep apnea (p = 0.008). SII, NLR, and PLR were not associated with PAP. Conclusions: Prolonged AF duration, CTI ablation, and sleep apnea are risk factors for PAP. The inflammatory markers (SII, NLR, and PLR) showed no association, warranting further investigation into other markers.

Colchicine Prevents Post-Ablation Atrial Fibrillation Recurrence: A Systematic Review and Meta-Analysis

Catheter ablation for atrial fibrillation (AF) is a commonly performed procedure, however, post-ablation AF recurrence is often observed due to inflammation and oxidative stress. Colchicine is a potent anti-inflammatory agent with conflicting efficacy in preventing post-ablation AF recurrence. A comprehensive literature search of the major bibliographic databases was conducted to retrieve studies comparing colchicine use versus placebo in AF patients post-ablation. Odds ratios (ORs) with 95% confidence intervals (CIs) were pooled using the DerSimonian-Laird random-effects model. Statistical significance was set at P < 0.05. Six studies were included with 1791 patients (721 in the colchicine group and 1070 in the placebo group). Patients who received colchicine had significantly lower odds of AF recurrence on follow-up (OR, 0.62; 95% CI, 0.48-0.79; P = 0.0001) but had higher gastrointestinal side effects (OR, 2.67; 95% CI, 1.00-7.12; P = 0.05). There were no statistically significant differences in acute pericarditis (OR, 0.54; 95% CI, 0.27-1.05; P = 0.07) or hospitalization (OR, 1.03; 95% CI, 0.73-1.45; P = 0.87). Prophylactic use of colchicine after catheter ablation in patients with AF leads to a reduction in AF recurrence, albeit with increased gastrointestinal side effects. Colchicine use did not lead to a reduction in the rates of pericarditis and hospitalization after ablation. Large randomized controlled trials are necessary to evaluate the efficacy of colchicine in preventing AF recurrence, particularly focusing on the dose and duration of treatment to optimize the side effect profile.

The efficacy of colchicine in preventing atrial fibrillation recurrence and pericarditis post-catheter ablation for atrial fibrillation - A systematic review and meta-analysis of prospective studies

Introduction

Catheter ablation (CA) initiates a proinflammatory process responsible for atrial fibrillation (AF) recurrence (25-40%) and pericarditis (0.8%). Due to its anti-inflammatory properties, colchicine, a microtubule inhibitor, is explored for the prevention of early AF recurrence and pericarditis after pulmonary vein isolation. We performed a pooled analysis to determine the rates of AF recurrence and pericarditis after CA in patients receiving colchicine.

Methods

A comprehensive literature review was conducted on PubMed and SCOPUS from inception to December 2023 using medical subject headings and keywords, followed by a citation and reference search. We identified prospective studies reporting recurrent AF and pericarditis outcomes after catheter ablation in patients taking colchicine versus placebo. A binary random effects model was used to estimate pooled odds ratios and 95% confidence intervals. Sensitivity analysis was conducted using the leave-one-out method, and heterogeneity was assessed using the I2 statistic.

Results

Of the 958 identified studies, 4 met our inclusion criteria. A total of 1,619 patients were analyzed; 743 received colchicine, and 875 were in the placebo group. Recurrent AF after CA occurred in 192 (29.0 %) of the colchicine group and 318 (39.5 %) of the placebo group. Post-ablation pericarditis occurred in 34 (5.3 %) of the colchicine group and 128 (16.5 %) of the placebo group. Pooled analysis of prospective studies showed that colchicine decreased the odds of recurrent AF [OR: 0.63 (95 % CI: 0.50-0.78), p < 0.01, I2  = 8 %] and post-ablation pericarditis [OR: 0.34 (95 % CI: 0.16-0.75), p < 0.01, I2  = 57 %]. Odds of GI disturbance were increased with colchicine use in our analysis [OR: 2.77 (95 % CI: 1.17-6.56), p = 0.02, I2  = 84 %].

Conclusion

Colchicine use is associated with decreased odds of recurrent AF and pericarditis post-CA from the analysis of prospective studies. These results underscore the potential for colchicine therapy for future exploration with randomized and controlled research with different dosages.

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

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 increase diarrhea.