There is no indication that short-term colchicine administration for 10 days reduces atrial arrhythmia recurrence or improves clinical outcomes in patients undergoing catheter ablation for atrial fibrillation (Afib). A small pilot study found that this was not the case.
Based on 14-day Holter monitoring, colchicine significantly reduced atrial arrhythmias immediately after ablation (31% vs. 32% in the placebo group, HR 0.98, 95% CI 0.59 to 1.61) and at 3 months (14% vs. 15%, HR 0.95). did not prevent recurrence. , 95% CI 0.45-2.02), reported Alexander Benz, MD, MSc, of the Institute of Population Health, McMaster University, Hamilton, Ontario.
Anti-inflammatory drugs also did not reduce total emergency department visits, cardiovascular hospitalizations, cardioversion, and repeat ablations during a median follow-up of 1.3 years (29 vs. 25 per 100 patient-years; HR 1.18, 95% CI 0.69) -1.99).
However, IMPROVE-PVI “was not sufficiently powered to definitively rule out a clinically important benefit from colchicine,” Benz and his team warned in a report published in 2016. Circulation: Arrhythmia and electrophysiology.
They highlighted the finding that colchicine reduced the incidence of post-ablation chest pain suggestive of pericarditis (4% vs 15%; HR 0.26, 95% CI 0.09-0.77).
“This reduction was observed within days after catheter ablation, suggesting an anti-inflammatory effect of short-term treatment with colchicine. “This is consistent with the evidence for the efficacy of colchicine,” Benz and colleagues wrote.
“Although our definition of pericarditis differed from a more stringent definition, the beneficial effects of colchicine on post-ablation chest pain observed in this double-blind, placebo-controlled trial were clinically meaningful. “There was,” the researchers claimed.
Colchicine is a widely prescribed anti-inflammatory agent known to have cardiovascular preventive effects.
Given that the success of catheter ablation with pulmonary vein isolation is often compromised by recurrent atrial arrhythmias, and such arrhythmias are predicted by inflammatory biomarkers, the investigators concluded that colchicine may be helpful. I was making a hypothesis.
As expected, colchicine therapy caused diarrhea as a side effect in IMPROVE-PVI. However, the incidence of diarrhea was particularly high in this trial compared with previous observations (26% vs 7% in the placebo group; HR 4.74, 95% CI 1.95-11.53).
“Possible reasons for the difference in diarrhea incidence between our study and other studies include differences in outcome definitions and patient characteristics, as well as potential interactions between colchicine and concomitant medications.” the authors suggested.
The study was conducted at a single center and enrolled patients scheduled for catheter ablation. People with contraindications to colchicine, i.e., those taking certain medications or those with severe gastrointestinal disease, obvious liver disease, or severe renal disease, were excluded.
Participants were randomly assigned to receive colchicine 0.6 mg twice daily or placebo for 10 days, starting within 4 hours of ablation.
Recurrent atrial arrhythmias were defined as atrial fibrillation, atrial flutter, or atrial tachycardia lasting >30 seconds on two 14-day Holter tests performed immediately after ablation and 3 months after ablation.
The study cohort consisted of 199 patients (median age 61 years, 22% women, 70% patients undergoing their first ablation procedure). System (21%).
Seventy-five percent of patients were prescribed antiarrhythmic drugs at discharge. At 6-month follow-up, the proportion of patients who discontinued antiarrhythmic therapy was 62.2% in the colchicine group and 57.0% in the placebo group.
There was one death from sepsis in the colchicine group, but none in the placebo group.
Benz and colleagues acknowledged that in addition to the small sample size, they did not use an implantable loop recorder to search for recurrent arrhythmias, which may have led to underestimation in both treatment groups.
Since IMPROVE-PVI was performed, another technique for catheter ablation, pulsed field ablation (PFA), has been approved by the FDA. His PulseSelect PFA system from Medtronic was approved last week, but his rival Farapulse PFA system from Boston Scientific has not yet been given the green light.
Unlike traditional catheter ablation for atrial fibrillation, PFA avoids thermal damage to the esophagus and phrenic nerves.
disclosure
This study was supported by the Hamilton Health Sciences New Investigator Fund and the Ontario Academic Health Sciences Center Alternative Funding Plan Innovation Fund.
Benz reported personal research grants from the German Heart Foundation and lecture fees from Bristol-Myers Squibb.
Primary information
Circulation: Arrhythmia and electrophysiology
Source reference: Benz AP, et al. “Colchicine to prevent atrial fibrillation recurrence after catheter ablation: A randomized, placebo-controlled trial.” Circ Arrhythm Electrophysiol 2023; DOI: 10.1161/CIRCEP.123.012387.