Clinical Research
Heart Rhythm Disorders
Colchicine for Prevention of Early Atrial Fibrillation Recurrence After Pulmonary Vein Isolation: A Randomized Controlled Study

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Objectives

The purpose of the present study was to test the potential of colchicine, an agent with potent anti-inflammatory action, to reduce atrial fibrillation (AF) recurrence after pulmonary vein isolation in patients with paroxysmal AF.

Background

Proinflammatory processes induced by AF ablation therapy have been implicated in postablation arrhythmia recurrence.

Methods

Patients with paroxysmal AF who received radiofrequency ablation treatment were randomized to a 3-month course of colchicine 0.5 mg twice daily or placebo. C-reactive protein (CRP) and interleukin (IL)-6 levels were measured on day 1 and on day 4 of treatment.

Results

In the 3-month follow-up, recurrence of AF was observed in 27 (33.5%) of 80 patients of the placebo group versus 13 (16%) of 81 patients who received colchicine (odds ratio: 0.38, 95% confidence interval: 0.18 to 0.80). Gastrointestinal side-effects were the most common symptom among patients receiving active treatment. Diarrhea was reported in 7 patients in the colchicine group (8.6%) versus 1 in the placebo group (1.3%, p = 0.03). Colchicine led to higher reductions in CRP and IL-6 levels: the median difference of CRP and IL-6 levels between days 4 and 1 was −0.46 mg/l (interquartile range: −0.78 to 0.08 mg/l) and −0.10 mg/l (−0.30 to 0.10 pg/ml), respectively, in the placebo group versus −1.18 mg/l (−2.35 to −0.46 mg/l) and −0.50 pg/ml (−1.15 to −0.10 pg/ml) in the colchicine group (p < 0.01 for both comparisons).

Conclusions

Colchicine is an effective and safe treatment for prevention of early AF recurrences after pulmonary vein isolation in the absence of antiarrhythmic drug treatment. This effect seems to be associated strongly with a significant decrease in inflammatory mediators, including IL-6 and CRP.

Key Words

ablation
atrial fibrillation
colchicine
C-reactive protein
inflammation
interleukin-6
radiofrequency

Abbreviations and Acronyms

AF
atrial fibrillation
CRP
C-reactive protein
IL
interleukin
IQR
interquartile range
MRAT
macro–re-entrant atrial tachycardia

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The authors have reported that they have no relationships relevant to the content of this paper to disclose.