Effect of ColchiciNe on the InciDence of Atrial Fibrillation in Open Heart Surgery Patients: END-AF Trial

Tabbalat, Ramzi; Hamad, Nidal; Alhaddad, Imad A.; Hammoudeh, Ayman; Akasheh, Bassam F.; Khader, Yousef

doi:10.1016/j.ahj.2016.05.006

Cited by 56 publications

(58 citation statements)

References 21 publications

(16 reference statements)

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“…Moreover, diarrhea occurred in 24.6% of patients treated with colchicine, and more than half of such patients required treatment discontinuation. 16 …”

Section: Introductionmentioning

confidence: 99%

Effect of Low-dose ColchiciNe on the InciDence of Atrial Fibrillation in Open Heart Surgery Patients: END-AF Low Dose Trial

et al. 2020

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Background Studies using 1 mg of colchicine to prevent postoperative atrial fibrillation (POAF) reported conflicting results. Moreover, colchicine was associated with significant gastrointestinal (GI) side effects. This study examined whether low-dose colchicine effectively prevents POAF and whether low-dose therapy is associated with lower rates of colchicine-induced GI side effects. Methods In this prospective, randomized, double-blind, placebo-controlled study, consecutive adult patients admitted for elective cardiac surgeries randomly received a 1-mg dose of colchicine (n = 81) or placebo (n = 71) orally 12 to 24 hours before surgery followed by a daily dose of 0.5 mg until hospital discharge. The primary efficacy endpoint was the development of at least one episode of POAF of ≥5 minutes. The primary safety endpoint was the development of adverse events, especially diarrhea. Results The in-hospital mortality rate was 3.9%. POAF occurred in 13 patients (16.1%) in the colchicine group and 13 patients (18.3%) in the placebo group (odds ratio 0.85 [95% Confidence Interval = 0.37−1.99]). Diarrhea occurred in two patients in each group and necessitated treatment discontinuation in one patient in each group. Conclusion Low-dose colchicine did not prevent POAF in patients undergoing cardiac surgery. These results should be interpreted cautiously because of the small sample size and early study termination. ClinicalTrials.gov Unique Identifier number: NCT03015831

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“…Moreover, diarrhea occurred in 24.6% of patients treated with colchicine, and more than half of such patients required treatment discontinuation. 16 …”

Section: Introductionmentioning

confidence: 99%

Effect of Low-dose ColchiciNe on the InciDence of Atrial Fibrillation in Open Heart Surgery Patients: END-AF Low Dose Trial

et al. 2020

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“…Similarly, gastrointestinal disturbances, as a side effect of colchicine, were the reason for dropout for more than one half of the patients in the colchicine group in the END-AF (Effect of Colchicine on the Incidence of Atrial Fibrillation in Open Heart Surgery Patients) trial. 13 This outcome could also be identified as a serious "confounding factor" that should be considered in interpreting the trial's neutral results regarding the efficacy of colchicine. Nevertheless, a nonsignificant 6% reduction in documented AF was recorded in the colchicine group.…”

Section: Discussionmentioning

confidence: 99%

“…In 2016, Tabbalat et al 13 published a study entitled "Effect of colchicine on the incidence of atrial fibrillation in open heart surgery patients: END-AF trial." The aim of this multicenter (5 centers in Jordan), randomized, open-label study was the incidence of POAF in patients with no history of AF or supraventricular tachycardia, undergoing cardiac surgery and who received colchicine preoperatively.…”

Section: Postoperative (Cardiac-thoracic Surgery) Af Randomized Contrmentioning

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 is also being investigated for reduction of AF recurrence following pulmonary vein isolation by Deftereos et al (2012 , 2014 ) in two studies treatment with colchicine initiated at the time of or 3 months following ablation reduced AF recurrence rate and increased recurrence-free time. While these studies suggest a potential role for colchicine treatment in AF, other studies have failed to show reduced POAF with colchicine treatment, warranting further investigation ( Meurin et al, 2015 ; Tabbalat et al, 2016 ; Zarpelon et al, 2016 ).…”

Section: Inflammationmentioning

confidence: 95%

Arrhythmogenic Substrates for Atrial Fibrillation in Obesity

2018

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Global obesity rates have nearly tripled since 1975. This obesity rate increase is mirrored by increases in atrial fibrillation (AF) that now impacts nearly 10% of Americans over the age of 65. Numerous epidemiologic studies have linked incidence of AF and obesity and other obesity-related diseases, including hypertension and diabetes. Due to the wealth of epidemiologic data linking AF with obesity-related disease, mechanisms of AF pathogenesis in the context of obesity are an area of ongoing investigation. However, progress has been somewhat slowed by the complex phenotype of obesity; separating the effects of obesity from those of related sequelae is problematic. While the initiation of pathogenic pathways leading to AF varies with disease (including increased glycosylation in diabetes, increased renin angiotensin aldosterone system activation in hypertension, atrial ischemia in coronary artery disease, and sleep apnea) the pathogenesis of AF is united by shared mediators of altered conduction in the atria. We suggest focusing on these downstream mediators of AF in obesity is likely to yield more broadly applicable data. In the context of obesity, AF is driven by the interrelated processes of inflammation, atrial remodeling, and oxidative stress. Obesity is characterized by a constant low-grade inflammation that leads to increased expression of pro-inflammatory cytokines. These cytokines contribute to changes in cardiomyocyte excitability. Atrial structural remodeling, including fibrosis, enlargement, and fatty infiltration is a prominent feature of AF and contributes to the altered conduction. Finally, obesity impacts oxidative stress. Within the cardiomyocyte, oxidative stress is increased through both increased production of reactive oxygen species and by downregulation of scavenging enzymes. This increased oxidative stress modulates of cardiomyocyte excitability, increasing susceptibility to AF. Although the initiating insults vary, inflammation, atrial remodeling, and oxidative stress are conserved mechanisms in the pathophysiology of AF in the obese patients. In this review, we highlight mechanisms that have been shown to be relevant in the pathogenesis of AF across obesity-related disease.

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Effect of ColchiciNe on the InciDence of Atrial Fibrillation in Open Heart Surgery Patients: END-AF Trial

Cited by 56 publications

References 21 publications

Effect of Low-dose ColchiciNe on the InciDence of Atrial Fibrillation in Open Heart Surgery Patients: END-AF Low Dose Trial

Effect of Low-dose ColchiciNe on the InciDence of Atrial Fibrillation in Open Heart Surgery Patients: END-AF Low Dose Trial

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

Arrhythmogenic Substrates for Atrial Fibrillation in Obesity

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