Colchicine for Prevention of Post-Operative Atrial Fibrillation: A Meta-Analysis

Justin Z Lee; Nirmal Singh; Carol L Howe; See-Wei Low; Jennifer J Huang; Gilbert Ortega; Kwan S Lee; Anil Pandit

doi:10.1016/j.jacep.2015.09.016

Colchicine for Prevention of Post-Operative Atrial Fibrillation: A Meta-Analysis

JACC Clin Electrophysiol. 2016 Feb;2(1):78-85. doi: 10.1016/j.jacep.2015.09.016. Epub 2015 Nov 10.

Authors

Justin Z Lee¹, Nirmal Singh¹, Carol L Howe², See-Wei Low¹, Jennifer J Huang¹, Gilbert Ortega³, Kwan S Lee⁴, Anil Pandit⁵

Affiliations

¹ Department of Internal Medicine, University of Arizona, Tucson, Arizona, USA.
² Arizona Health Sciences Library, University of Arizona, Tucson, Arizona, USA.
³ College of Medicine, University of Arizona, Tucson, Arizona, USA.
⁴ Department of Cardiovascular Diseases, University of Arizona, Tucson, Arizona, USA. Electronic address: klee@shc.arizona.edu.
⁵ DeBakey Heart Institute, Hays, Kansas, USA.

PMID: 29766857
DOI: 10.1016/j.jacep.2015.09.016

Abstract

Objectives: This study sought to investigate the efficacy and safety of colchicine for prevention of post-operative atrial fibrillation.

Background: Proinflammatory processes induced during cardiac surgery may contribute toward post-operative atrial fibrillation (AF). Colchicine is a potent anti-inflammatory agent, which may have a role in post-operative AF prevention.

Methods: We searched PubMed, EMBASE, Web of Science, CINAHL, ClinicalTrials.gov, and the Cochrane Library databases for randomized controlled trials (RCT) comparing colchicine versus placebo for prevention of post-operative AF. The main outcome measure of interest was the development of AF within 12 months after cardiac surgery. The overall risk ratio (RR) for the development of post-operative AF was computed using a random-effects model.

Results: Data analyzed from 3 randomized studies with a total of 912 patients, where 457 patients received colchicine and 455 patients received placebo, showed that perioperative colchicine therapy was associated with a reduced incidence of post-operative AF (RR: 0.65; 95% confidence interval [CI]: 0.46 to 0.91; p < 0.01). Although colchicine therapy was associated with increased incidence of gastrointestinal intolerance (RR: 2.20; 95% CI: 1.31 to 3.70; p = 0.003), it was not associated with early treatment discontinuation (RR: 1.37; 95% CI: 0.95 to 1.96; p = 0.09).

Conclusions: In conclusion, current evidence suggests that colchicine therapy is efficacious for the prevention of post-operative AF, and may be considered as adjunctive prophylaxis. Further studies may be required to determine the optimal treatment protocol to reduce the incidence of gastrointestinal intolerance.

Keywords: atrial fibrillation; colchicine; post-operative atrial fibrillation.