Colchicine for primary prevention of atrial fibrillation after open-heart surgery: Systematic review and meta-analysis

Lennerz, Carsten; Barman, M; Tantawy, Mahmoud; Sopher, Mark; Whittaker, Peter

doi:10.1016/j.ijcard.2017.08.039

Cited by 79 publications

(64 citation statements)

References 42 publications

(54 reference statements)

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“…Arrhythmias accounted for about one in five readmissions. There is continued data to suggest that prophylactic colchicine may reduce the incidence of postoperative atrial fibrillation, yet this practice has not been widely adopted and merits further study in light of the potential impact on patient outcomes and readmission prevention …”

Section: Discussionmentioning

confidence: 99%

“…There is continued data to suggest that prophylactic colchicine may reduce the incidence of postoperative atrial fibrillation, yet this practice has not been widely adopted and merits further study in light of the potential impact on patient outcomes and readmission prevention. 27 There is an unfortunate gap in the literature regarding evidencebased interventions to reduce readmissions following cardiac surgery. 28 Early efforts to improve the management of CHF patients, based largely on improving care coordination, may provide a model for cardiac surgical patients.…”

Section: Preoperative Predictors Of Readmissionmentioning

confidence: 99%

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A multi‐center analysis of readmission after cardiac surgery: Experience of The Northern New England Cardiovascular Disease Study Group

et al. 2019

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Background Readmissions after cardiac surgery are common and associated with increased morbidity, mortality and cost of care. Policymakers have targeted coronary artery bypass grafting to achieve value‐oriented health care milestones. We explored the causes of readmission following cardiac surgery among a regional consortium of hospitals. Methods Using administrative data, we identified patients readmitted to the same institution within 30 days of cardiac surgery. We performed standardized review of readmitted patients’ medical records to identify primary and secondary causes of readmission. We evaluated causes of readmission by procedure and tested for univariate associations between characteristics of readmitted patients and nonreadmitted patients in our clinical registry. Results Of 2218 cardiac surgery patients, 272 were readmitted to the index hospital within 30 days for a readmission rate of 12.3%. Median time to readmission was 9 days (interquartile range 4‐16 days) and only 13% of patients were evaluated in‐office before readmission. Readmitted patients were more likely to have had valve surgery (31.3% vs 22.7%) than patients not readmitted. Readmitted patients were also more likely to have preoperative creatinine more than or equal to 2 mg/dL (P = .015) or congestive heart failure (CHF) (P = .034), require multiple blood transfusions or sustained inotropic support (P < .001), and experience postoperative atrial fibrillation (P = .022) or renal insufficiency (P < .001). Infection (26%), pleural or pericardial effusion (19%), arrhythmia (16%), and CHF (11%) were the most common primary etiologies leading to readmission. Conclusions Ensuring early follow‐up for high‐risk patient groups while improving early detection and management of the principal drivers of readmission represent promising targets for decreasing readmission rates.

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Section: Discussionmentioning

confidence: 99%

Section: Preoperative Predictors Of Readmissionmentioning

confidence: 99%

A multi‐center analysis of readmission after cardiac surgery: Experience of The Northern New England Cardiovascular Disease Study Group

et al. 2019

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“…This result might suggest a higher association between EATa and AF (Batal et al, ) because the neutrophil to lymphocyte ratio was an AF recurrence predictor after ablation or new onset AF after CABG (Gibson et al, ; Li, Cui, Ma, Ma, & Li, ). Along this line, colchicine, which reduces neutrophils' activity (Paschke et al, ), was shown to be efficient for AF prevention after cardiac surgery (Lennerz, Barman, Tantawy, Sopher, & Whittaker, ). Although colchicine might cause leukopenia in a dose‐independent manner (Dixon & Wall, ), leukocytes deficiency was associated with worse clinical outcomes in patients who underwent heart surgery (Cabrera et al, ).…”

Section: Discussionmentioning

confidence: 99%

Cholinergic activity regulates the secretome of epicardial adipose tissue: Association with atrial fibrillation

Couselo‐Seijas

Lopez-Canoa

Agra-Bermejo

et al. 2018

Journal Cellular Physiology

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Botulinum toxin injection on epicardial fat, which inhibits acetylcholine (ACh) release, reduced the presence of atrial fibrillation (AF) in patients after heart surgery. Thus, we wanted to study the profile of the released proteins of epicardial adipose tissue (EAT) under cholinergic activity (ACh treatment) and their value as AF predictors. Biopsies, explants, or primary cultures were obtained from the EAT of 85 patients that underwent open heart surgery. The quantification of muscarinic receptors (mAChR) by real‐time polymerase chain reaction or western blot showed their expression in EAT. Moreover, mAChR Type 3 was upregulated after adipogenesis induction (p < 0.05). Cholinergic fibers in EAT were detected by vesicular ACh transporter levels and/or acetylcholinesterase activity. ACh treatment modified the released proteins by EAT, which were identified by nano‐high‐performance liquid chromatography and TripleTOF analysis. These differentially released proteins were involved in cell structure, inflammation, or detoxification. After testing the plasma levels of alpha‐defensin 3 (inflammation‐involved protein) of patients who underwent open heart surgery ( n = 24), we observed differential levels between the patients who developed or did not develop postsurgery AF (1.58 ± 1.61 ng/ml vs. 6.2 ± 5.6 ng/ml; p < 0.005). The cholinergic activity on EAT might suggest a new mechanism for studying the interplay among EAT, autonomic nervous system dysfunction, and AF.

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“…In 2017, a meta-analysis by Lennerz et al 19 focused on 1412 patients undergoing cardiac surgery. The primary end point was POAF after treatment with colchicine; secondary end points included hospitalization length and side effects after colchicine treatment.…”

Section: Meta-analysesmentioning

confidence: 99%

The Role of Colchicine in Treating Postoperative and Post-catheter Ablation Atrial Fibrillation

Deftereos

Vrachatis

Angelidis

et al. 2019

Clinical Therapeutics

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AF occurs frequently after cardiac surgery (POAF) and catheter pulmonary vein isolation (postablation AF) and is associated with increased cardiovascular morbidity. A number of trials over the last few years have investigated the role of colchicine in the prevention of POAF and postablation AF targeting the local and systemic inflammatory process that leads to initiation and maintenance of AF. Available data imply that colchicine may have a preventive role in POAF and/or postablation AF. However, certain limitations of these studies underline the need for further investigation.

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Colchicine for primary prevention of atrial fibrillation after open-heart surgery: Systematic review and meta-analysis

Cited by 79 publications

References 42 publications

A multi‐center analysis of readmission after cardiac surgery: Experience of The Northern New England Cardiovascular Disease Study Group

A multi‐center analysis of readmission after cardiac surgery: Experience of The Northern New England Cardiovascular Disease Study Group

Cholinergic activity regulates the secretome of epicardial adipose tissue: Association with atrial fibrillation

The Role of Colchicine in Treating Postoperative and Post-catheter Ablation Atrial Fibrillation

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