Colchicine for prevention of post-cardiac procedure atrial fibrillation: Meta-analysis of randomized controlled trials
Introduction
Atrial fibrillation (AF) is a common complication of certain cardiac procedures such as coronary artery bypass graft, valve surgery and pulmonary vein isolation (PVI). The estimated incidence of post-cardiac procedure atrial fibrillation (PCP-AF) is from 30% to 50% [1], [2]. This incidence is affected by multiple factors including the type and complexity of the procedure, intraoperative sequels and patient age [3], [4]. PCP-AF is associated with prolonged hospitalization, expanded costs, increased morbidity, and all-cause mortality [5], [6], [7], [8]. Several drugs have been evaluated to prevent PCP-AF including amiodarone, beta blockers, magnesium, and statins [9], [10]. Since inflammation plays an important role in the pathogenesis of PCP-AF, several anti-inflammatory agents have been used to treat AF in the periprocedural period [11], [12], [13]. Recently, colchicine has been shown to reduce the early recurrence of AF observed after PVI with radiofrequency (RF) catheter ablation [10]. Some patients have more AF recurrence immediately or within the next few weeks after PVI because of the inflammation associated with RF lesions [14], [15]. Interestingly, the incidence of early AF recurrence is not significantly different from that reported after maze surgery [16], [17]. Recent evidence suggests that prevention strategies for reducing the incidence of PCP-AF are currently underused. In this study, we aim to review the available evidence from randomized controlled trials (RCTs) to assess the efficacy and safety of colchicine in prevention of PCP-AF after cardiac surgery and PVI.
Section snippets
Search strategy
A systematic search for eligible studies was conducted and relevant articles were retrieved until April 2016 by searching PubMed, EMBASE, Web of Science, the Cochrane Library and Google Scholar using the following key words: atrial fibrillation, atrial, or fibrillation and colchicine, supplemented by references from the selected articles and by abstracts from conference proceedings, to mitigate publication bias. After a primary search, 143 articles were identified and 15 possibly pertinent
Results
Six studies involving 1257 patients were included in our meta-analysis [18], [19], [20], [21], [22], [23]. Three RCTs enrolled patients who underwent cardiac surgery [18], [19], [20], and 3 RCTs enrolled patients post PVI with radiofrequency (RF) catheter ablation [21], [22], [23]. The characteristics of the six studies and patients are summarized in Table 1, Table 2, respectively. The treatment duration ranged from one week to 3 months. Colchicine significantly reduced the odds of PCP-AF (OR
Main finding
To our knowledge, this is the largest meta-analysis on the efficacy of colchicine to prevent PCP-AF. It included six RCTs enrolling a total of 1257 patients undergoing cardiac surgery and RF catheter ablation for AF. The use of colchicine in the periprocedural period significantly reduced the odds of PCP-AF by an estimated 48%. However, colchicine was associated with higher side effects, compared to placebo, and 16% drug discontinuation.
Mechanisms
The exact pathophysiology of PCP-AF is multifactorial and
Limitations
Our meta-analysis shares the limitations inherent to the studies analyzed. One limitation of our analysis is the relative heterogeneity in the type of cardiac procedures (interventional procedure with AF ablation and cardiac surgery) performed among the included trials. Some cardiac procedures are associated with higher incidence of AF compared to others [9]. However, these procedures share a similar mechanism for a common complication (AF) with the same treatment (colchicine) that warranted
Conclusion
Colchicine appears to be effective in prevention of PCP-AF and early recurrence of AF post PVI. However, the relatively more frequent adverse effects and treatment discontinuations may curtail its utility. Future studies are needed to determine the optimal dosage and duration of colchicine therapy in prevention of PCP-AF.
Conflict of interest
The authors report no relationships that could be construed as a conflict of interest except Dr. Charnigo has been a co-investigator on two grants from AstraZeneca and has traded IBM stock and/or stock options.
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