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Benz AP, Amit G, Connolly SJ, Singh J, Acosta-Vélez JG, Conen D, Deif B, Divakaramenon S, McIntyre WF, Mtwesi V, Roberts JD, Wong JA, Zhao R, Healey JS. Colchicine to Prevent Atrial Fibrillation Recurrence After Catheter Ablation: A Randomized, Placebo-Controlled Trial. Circ Arrhythm Electrophysiol 2024; 17:e01238. [PMID: 38126206 DOI: 10.1161/circep.123.012387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 11/22/2023] [Indexed: 12/23/2023]
Abstract
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.
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Affiliation(s)
- Alexander P Benz
- Population Health Research Institute (A.P.B., S.J.C., J.S., D.C., W.F.M., J.D.R., J.A.W., R.Z., J.S.H.), Hamilton, ON, Canada
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg-University, Germany (A.P.B.)
| | - Guy Amit
- Cardiac Electrophysiology and Pacing, Division of Cardiology, Department of Medicine (G.A., J.G.A.-V., S.D., J.D.R., J.A.W., J.S.H.), Hamilton, ON, Canada
| | - Stuart J Connolly
- Population Health Research Institute (A.P.B., S.J.C., J.S., D.C., W.F.M., J.D.R., J.A.W., R.Z., J.S.H.), Hamilton, ON, Canada
| | - Jasrita Singh
- Population Health Research Institute (A.P.B., S.J.C., J.S., D.C., W.F.M., J.D.R., J.A.W., R.Z., J.S.H.), Hamilton, ON, Canada
- Cardiac Electrophysiology and Pacing, Division of Cardiology, Department of Medicine (G.A., J.G.A.-V., S.D., J.D.R., J.A.W., J.S.H.), Hamilton, ON, Canada
| | - Juan G Acosta-Vélez
- Cardiac Electrophysiology and Pacing, Division of Cardiology, Department of Medicine (G.A., J.G.A.-V., S.D., J.D.R., J.A.W., J.S.H.), Hamilton, ON, Canada
| | - David Conen
- Population Health Research Institute (A.P.B., S.J.C., J.S., D.C., W.F.M., J.D.R., J.A.W., R.Z., J.S.H.), Hamilton, ON, Canada
| | - Bishoy Deif
- Royal Victoria Hospital, Barrie, ON, Canada (B.D.)
| | - Syamkumar Divakaramenon
- Cardiac Electrophysiology and Pacing, Division of Cardiology, Department of Medicine (G.A., J.G.A.-V., S.D., J.D.R., J.A.W., J.S.H.), Hamilton, ON, Canada
| | - William F McIntyre
- Population Health Research Institute (A.P.B., S.J.C., J.S., D.C., W.F.M., J.D.R., J.A.W., R.Z., J.S.H.), Hamilton, ON, Canada
| | - Viwe Mtwesi
- Division of Cardiology, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa (V.M.)
| | - Jason D Roberts
- Population Health Research Institute (A.P.B., S.J.C., J.S., D.C., W.F.M., J.D.R., J.A.W., R.Z., J.S.H.), Hamilton, ON, Canada
- Cardiac Electrophysiology and Pacing, Division of Cardiology, Department of Medicine (G.A., J.G.A.-V., S.D., J.D.R., J.A.W., J.S.H.), Hamilton, ON, Canada
| | - Jorge A Wong
- Population Health Research Institute (A.P.B., S.J.C., J.S., D.C., W.F.M., J.D.R., J.A.W., R.Z., J.S.H.), Hamilton, ON, Canada
- Cardiac Electrophysiology and Pacing, Division of Cardiology, Department of Medicine (G.A., J.G.A.-V., S.D., J.D.R., J.A.W., J.S.H.), Hamilton, ON, Canada
| | - Robin Zhao
- Population Health Research Institute (A.P.B., S.J.C., J.S., D.C., W.F.M., J.D.R., J.A.W., R.Z., J.S.H.), Hamilton, ON, Canada
| | - Jeff S Healey
- Population Health Research Institute (A.P.B., S.J.C., J.S., D.C., W.F.M., J.D.R., J.A.W., R.Z., J.S.H.), Hamilton, ON, Canada
- Cardiac Electrophysiology and Pacing, Division of Cardiology, Department of Medicine (G.A., J.G.A.-V., S.D., J.D.R., J.A.W., J.S.H.), Hamilton, ON, Canada
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