The efficacy of colchicine in preventing atrial fibrillation recurrence and pericarditis post-catheter ablation for atrial fibrillation - A systematic review and meta-analysis of prospective studies

Vamsikalyan Borra; Arankesh Mahadevan; Sidhartha Gautam Senapati; Roopeessh Vempati; Vikash Jaiswal; Nithya Borra; Javaria Ahmad; Oscar Rodrigo Zamudio Herrera; Carlos Vergara Sanchez; Tanisha Prasad; Rosy Thachil; Sarju Ganatra; Sourbha Dani

doi:10.1016/j.ijcha.2024.101466

The efficacy of colchicine in preventing atrial fibrillation recurrence and pericarditis post-catheter ablation for atrial fibrillation - A systematic review and meta-analysis of prospective studies

Int J Cardiol Heart Vasc. 2024 Jul 25:53:101466. doi: 10.1016/j.ijcha.2024.101466. eCollection 2024 Aug.

Affiliations

¹ Department of Internal Medicine, The University of Texas Rio Grande Valley, Edinburg, TX, USA.
² Department of Internal Medicine, SRM Medical College Hospital and Research Centre, Tamil Nadu, India.
³ Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA.
⁴ Department of Internal Medicine, Trinity Health Oakland, Pontiac, MI, USA.
⁵ Department of Cardiovascular Research, Larkin Community Hospital, South Miami, FL, USA.
⁶ Department of Internal Medicine, Sri Venkateswara Medical College, Tirupati, Andhra Pradesh, India.
⁷ Divison of Cardiovascular Medicine, Department of Medicine, Lahey Hospital & Medical Center, Burlington, MA, USA.
⁸ Department of Cardiology, Marshall University Joan C. Edwards School of Medicine, Huntington, WV, USA.
⁹ Department of Cardiology, Mayo Clinic, Jacksonville, FL, USA.
¹⁰ Department of Medicine, Royal College Surgeons, Dublin, Ireland.
¹¹ Division of Cardiology, Newyork City Health+Hospitals/Elmhurst, Mount Sinai School of Medicine, Queens, NY, USA.

Abstract

Introduction: Catheter ablation (CA) initiates a proinflammatory process responsible for atrial fibrillation (AF) recurrence (25-40%) and pericarditis (0.8%). Due to its anti-inflammatory properties, colchicine, a microtubule inhibitor, is explored for the prevention of early AF recurrence and pericarditis after pulmonary vein isolation. We performed a pooled analysis to determine the rates of AF recurrence and pericarditis after CA in patients receiving colchicine.

Methods: A comprehensive literature review was conducted on PubMed and SCOPUS from inception to December 2023 using medical subject headings and keywords, followed by a citation and reference search. We identified prospective studies reporting recurrent AF and pericarditis outcomes after catheter ablation in patients taking colchicine versus placebo. A binary random effects model was used to estimate pooled odds ratios and 95% confidence intervals. Sensitivity analysis was conducted using the leave-one-out method, and heterogeneity was assessed using the I² statistic.

Results: Of the 958 identified studies, 4 met our inclusion criteria. A total of 1,619 patients were analyzed; 743 received colchicine, and 875 were in the placebo group. Recurrent AF after CA occurred in 192 (29.0 %) of the colchicine group and 318 (39.5 %) of the placebo group. Post-ablation pericarditis occurred in 34 (5.3 %) of the colchicine group and 128 (16.5 %) of the placebo group. Pooled analysis of prospective studies showed that colchicine decreased the odds of recurrent AF [OR: 0.63 (95 % CI: 0.50-0.78), p < 0.01, I² = 8 %] and post-ablation pericarditis [OR: 0.34 (95 % CI: 0.16-0.75), p < 0.01, I² = 57 %]. Odds of GI disturbance were increased with colchicine use in our analysis [OR: 2.77 (95 % CI: 1.17-6.56), p = 0.02, I² = 84 %].

Conclusion: Colchicine use is associated with decreased odds of recurrent AF and pericarditis post-CA from the analysis of prospective studies. These results underscore the potential for colchicine therapy for future exploration with randomized and controlled research with different dosages.

Keywords: Atrial fibrillation; Catheter ablation; Colchicine; Pericarditis.