Impact of Colchicine Monotherapy on the Risk of Acute Pericarditis Following Atrial Fibrillation Ablation

Mohanty, Sanghamitra; Mohanty, Prasant; Kessler, Danielle A.; Gianni, Carola; Baho, Karim; Morris, Trevor; Yıldız, Tuna; Mayedo, Angel; MacDonald, Bryan; Rocca, Domenico G. Della; Al‐Ahmad, Amin; Bassiouny, Mohamed; Gallinghouse, G. Joseph; Horton, Rodney; Burkhardt, J. David; Biase, Luigi Di

doi:10.1016/j.jacep.2023.01.037

Cited by 5 publications

(3 citation statements)

References 18 publications

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“…25 However, periablation use of colchicine was associated with a reduction in pericarditis in a recent observational study. 26 Although gastrointestinal side effects are relatively common with colchicine, the increase in diarrhea with the 10-day treatment was substantial and clinically significant. The observed 26% incidence in the intervention arm is much higher than in previous trials testing colchicine at doses of ≥1.0 mg per day.…”

Section: Discussionmentioning

confidence: 99%

Colchicine to Prevent Atrial Fibrillation Recurrence After Catheter Ablation: A Randomized, Placebo-Controlled Trial

Benz,

Amit,

Connolly

et al. 2024

Circ: Arrhythmia and Electrophysiology

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BACKGROUND: Inflammation may promote atrial fibrillation (AF) recurrence after catheter ablation. This study aimed to evaluate a short-term anti-inflammatory treatment with colchicine following ablation of AF. METHODS: Patients scheduled for ablation were randomized to receive colchicine 0.6 mg twice daily or placebo for 10 days. The first dose of the study drug was administered within 4 hours before ablation. Atrial arrhythmia recurrence was defined as AF, atrial flutter, or atrial tachycardia >30 s on two 14-day Holters performed immediately and at 3 months following ablation. RESULTS: The modified intention-to-treat population included 199 patients (median age, 61 years; 22% female; 70% first procedure) who underwent radiofrequency (79%) or cryoballoon ablation (21%) of AF. Antiarrhythmic drugs were prescribed at discharge in 149 (75%) patients. Colchicine did not prevent atrial arrhythmia recurrence at 2 weeks (31% versus 32%; hazard ratio [HR], 0.98 [95% CI, 0.59–1.61]; P =0.92) or at 3 months following ablation (14% versus 15%; HR, 0.95 [95% CI, 0.45–2.02]; P =0.89). Postablation chest pain consistent with pericarditis was reduced with colchicine (4% versus 15%; HR, 0.26 [95% CI, 0.09–0.77]; P =0.02) and colchicine increased diarrhea (26% versus 7%; HR, 4.74 [95% CI, 1.95–11.53]; P <0.001). During a median follow-up of 1.3 years, colchicine did not reduce a composite of emergency department visit, cardiovascular hospitalization, cardioversion, or repeat ablation (29 versus 25 per 100 patient-years; HR, 1.18 [95% CI, 0.69–1.99]; P =0.55). CONCLUSIONS: Colchicine administered for 10 days following catheter ablation did not reduce atrial arrhythmia recurrence or AF-associated clinical events, but did reduce postablation chest pain and increased diarrhea.

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Section: Discussionmentioning

confidence: 99%

Colchicine to Prevent Atrial Fibrillation Recurrence After Catheter Ablation: A Randomized, Placebo-Controlled Trial

Benz,

Amit,

Connolly

et al. 2024

Circ: Arrhythmia and Electrophysiology

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“…11 In a prospective study of 1,075 patients undergoing RF ablations, prophylactic use of colchicine given at 0.3 mg twice daily ranging from 7 days to 1 month prior to ablation was found to reduce the incidence of post-ablation chest pain. 8 However, the study was neither randomized nor blinded, which may limit the generalizability of its findings. In contrast, a randomized study of 139 patients did not demonstrate a clear relationship between post-ablation acute pericarditis and prophylactic colchicine use.…”

Section: Discussionmentioning

confidence: 99%

“…For example, colchicine has been evaluated for its potential role as a prophylactic medication. 75 While a non-randomized study found colchicine to be effective, 8 a randomized study found it ineffective and reported significant gastrointestinal side effects. 9 As such, effective prophylactic treatment regimens remain unclear, while instances of postablation chest pain remain high, with reports ranging from 10% to more than 50% of patients experiencing post-ablative chest pain.…”

Section: Introductionmentioning

confidence: 99%

Reduced Post-Ablation Chest Pain with Active Esophageal Cooling

Zagrodzky,

Small,

Joseph

et al. 2023

Preprint

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Introduction: Post-ablation chest pain is a common occurrence in patients after radiofrequency (RF) pulmonary vein isolation (PVI) ablation for the treatment of atrial fibrillation (AF), with a reported incidence of up to 50%. Pain can be caused by pericarditis, vagal plexus thermal injury, gastroparesis, or local inflammation. Active esophageal cooling is FDA cleared for reducing the likelihood of ablation-related esophageal injury resulting from RF cardiac ablation procedures, but cooling has also been reported to have pleiotropic effects which may mitigate inflammation and reduce the likelihood of post-ablation chest pain. The aim of this study is to quantify the change in incidence of post-ablation chest pain after the adoption of active esophageal cooling during RF ablations. Methods: Data from a community hospital registry were obtained for the 12 months prior to (pre-adoption), and the 12 months after adoption (post-adoption) of active esophageal cooling in December 2021 during RF ablations. Type of ablation was recorded, along with patient’s age, post-ablation symptoms, and type of prophylactic treatment utilized. Incidence rates of chest pain before and after adoption of esophageal cooling were then compared. Results: Data were reviewed from 183 patients. In the pre-adoption cohort, patients were given 2 weeks of daily sucralfate and pantoprazole, with an additional 4 weeks in cases with persisting symptoms. In this group, 90 patients (66.7% persistent AF) with a mean age of 69.6 years (SD ± 10.34) received PVI, with 62 (68.9%) receiving roof lines, 60 (66.7%) receiving floor lines, and 41 (45.6%) reporting post-ablation chest pain requiring extension of treatment to 6 weeks. In the post-adoption cohort, 2 days of sucralfate and pantoprazole was given, and a total of 93 patients (75.2% persistent AF) with a mean age of 68.3 years (SD ± 10.28) received PVI, with 79 (84.5%) receiving roof lines, 75 (80.6%) receiving floor lines, and none reporting post-ablation chest pain (p<0.0001). Conclusion: Adoption of active esophageal cooling was associated with a significant reduction in post-ablation chest pain despite increased use of posterior wall isolation and decreased use of prophylactic treatment.

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Safety and Efficacy of Colchicine for the Prevention of Pericarditis in Patients Who Underwent Catheter Ablation for Atrial Fibrillation

Agarwal,

Hashim,

et al. 2023

The American Journal of Cardiology

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Impact of Colchicine Monotherapy on the Risk of Acute Pericarditis Following Atrial Fibrillation Ablation

Cited by 5 publications

References 18 publications

Colchicine to Prevent Atrial Fibrillation Recurrence After Catheter Ablation: A Randomized, Placebo-Controlled Trial

Colchicine to Prevent Atrial Fibrillation Recurrence After Catheter Ablation: A Randomized, Placebo-Controlled Trial

Reduced Post-Ablation Chest Pain with Active Esophageal Cooling

Safety and Efficacy of Colchicine for the Prevention of Pericarditis in Patients Who Underwent Catheter Ablation for Atrial Fibrillation

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