The Effect of Colchicine on Atrial Fibrillation: A Systematic Review and Meta-Analysis

Abstract

Colchicine is a potent anti-inflammatory agent whose benefits have been explored for various conditions, including atrial fibrillation (AF). In this article, we tried to understand why colchicine might be beneficial in AF and reviewed various studies that looked at the effect of colchicine against AF. We followed the PRISMA algorithm and undertook a literature search to identify studies with control groups that looked at the effect of colchicine against AF and conducted a meta-analysis. We identified six studies on post-cardiac surgical patients, three on post-pulmonary vein isolation (PVI)/ablation patients, and two on coronary artery disease. In patients who underwent cardiac surgery, we found that colchicine is beneficial against postoperative atrial fibrillation (POAF) with a relative risk (RR) of 0.70 (95% CI of 0.58 to 0.84) and a p-value of 0.0001. We also found that in patients who underwent PVI/ablation, colchicine is beneficial in decreasing AF recurrence over three months with an RR of 0.57 (95% CI of 0.39 to 0.83) and a p-value of 0.0032 and over 12 months follow-up with an RR of 0.58 (95% CI of 0.42 -0.80) and a p-value of 0.0008. Our metaanalysis showed that in patients with coronary artery disease, colchicine had no significant benefit in decreasing the incidence of AF with a hazard ratio (HR) of 0.86 (95% CI of 0.69 -1.06) and a p-value of 0.16. From this study, we conclude that colchicine may be beneficial for decreasing the incidence of AF in postcardiac surgery patients and post-PVI/ablation patients. It may not decrease the incidence of AF in patients with coronary artery disease.

Advancing drug development for atrial fibrillation by prioritising findings from human genetic association studies

“…It demonstrated a reduced risk of recurrence over a 12-month period. 84 Whilst not in the same class of drugs, vinorelbine is a chemotherapeutic agent that acts by the inhibition of tubulin which is encoded by the same target TUBB3 . An RCT comparing vinorelbine combined with gemcitabine vs gemcitabine alone in patients with stage III or IV non-small cell lung cancer demonstrated a higher rate of incident AF.…”

Efficacy and safety of colchicine for the prevention of postoperative atrial fibrillation among patients undergoing major cardiothoracic surgery: a meta-analysis and meta-regression of randomized controlled trials

“…Interestingly, they found out that the incidence of major adverse events was not increased (RR: 0.86; 95% CI, 0.46–1.60; P = 0.64) in the colchicine arm indicating the relative safety of colchicine among patients who underwent cardiothoracic surgery. Looking at cardiac surgery alone, Kommu et al 19 established colchicine was beneficial against POAF (RR: 0.70; 95% CI, 0.58–0.84; P < 0.001). In this study, they included patients who underwent catheter-based procedure.…”

Colchicine for the treatment of the spectrum of cardiovascular diseases: current evidence and ongoing perspectives

“…Colchicine may prevent atrial fibrillation with different anti-inflammatory mechanisms: inhibition of IL-6 release and consequent fibrosis; activation of the PI3K/AKT/eNOS signalling pathway, which may reverse atrial remodelling; and reduction of NLRP3 inflammasome activity. [42][43][44] A recent meta-analysis 45 evaluated the use of colchicine in preventing atrial fibrillation in three different settings: postoperative atrial fibrillation (POAF) after cardiac surgery, atrial fibrillation recurrence following pulmonary vein ablation/isolation, and atrial fibrillation in patients with CAD. The meta-analysis found that colchicine is beneficial in decreasing the incidence of POAF, with a relative risk of 0.7 (95% CI 0.58-0.84).…”