Colchicine fails to prevent atrial arrhythmia recurrence after ablation for AF, finds trial

“Through 14-day Holter monitoring, colchicine failed to prevent the recurrence of atrial arrhythmia after ablation (31% versus 32% with placebo; HR 0.98) nor at three months (14% versus 15%; HR 0.95),” Alexander P. Benz, Population Health Research Institute at McMaster University in Hamilton, Ontario, and colleagues reported in the study published in Circulation: Arrhythmia and Electrophysiology.

During a median follow-up of 1.3 years, the anti-inflammatory drug also did not lower the composite of cardiovascular hospitalizations, emergency department visits, cardioversions, or repeat ablations (29 vs 25 per 100 patient-years; HR 1.18).

Inflammation may promote the recurrence of atrial fibrillation after catheter ablation. Colchicine is a widely prescribed anti-inflammatory agent that has cardiovascular prevention benefits. Therefore, Dr. Benz and colleagues aimed to evaluate a short-term anti-inflammatory treatment with colchicine following AF ablation.

For this purpose, the patients scheduled for ablation were randomized to receive twice daily colchicine 0.6 mg or placebo for 10 days. The study drug’s first dose was administered within 4 hours before ablation.

Atrial arrhythmia recurrence was defined as atrial fibrillation, atrial flutter, or atrial tachycardia >30 s on two 14-day Holters performed immediately and at 3 months following ablation.

Based on the study, the researchers reported the following findings:

· 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 75% of patients.

· Colchicine did not prevent atrial arrhythmia recurrence at 2 weeks (31% versus 32%; hazard ratio [HR]) or 3 months following ablation (14% versus 15%; HR, 0.95).

· Postablation chest pain consistent with pericarditis was reduced with colchicine (4% versus 15%; HR, 0.26) and colchicine increased diarrhoea (26% versus 7%; HR, 4.74).

· During a median follow-up of 1.3 years, colchicine did not reduce a composite of emergency department visits, cardioversion, cardiovascular hospitalization, or repeat ablation (29 versus 25 per 100 patient-years; HR, 1.18).

Limitations include small samples, recurrent arrhythmias were not looked at using implantable loop recorders that would likely result in an undercounting in both treatment groups.

“For patients undergoing catheter ablation for AF there was no signal that a brief course of colchicine reduced atrial arrhythmia recurrence or improved clinical outcomes when taken for 10 days starting right before the procedure,” the researchers concluded.

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.