Colchicine for Prevention of Early Atrial Fibrillation Recurrence After Pulmonary Vein Isolation A Randomized Controlled Study

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:60

Article

Deftereos, Spyridon¹  Giannopoulos, Georgios¹  Kossyvakis, Charalambos¹  Efremidis, Michael²  Panagopoulou, Vasiliki¹  Kaoukis, Andreas¹  Raisakis, Konstantinos¹  Bouras, Georgios¹  Angelidis, Christos¹  Theodorakis, Andreas³  Driva, Metaxia¹  Doudoumis, Konstantinos¹  Pyrgakis, Vlasios¹  Stefanadis, Christodoulos⁴ 

[1] Athens Gen Hosp G Gennimatas, Dept Cardiol, Athens 11527, Greece

[2] Evaggelismos Gen Hosp, Dept Cardiol 2, Athens, Greece

[3] Mesologgi Gen Hosp, Dept Cardiol, Mesologgi, Greece

[4] Univ Athens, Sch Med, Dept Cardiol 1, GR-11527 Athens, Greece

关键词: ablation;    atrial fibrillation;    colchicine;    C-reactive protein;    inflammation;    interleukin-6;    radiofrequency;   

DOI  :  10.1016/j.jacc.2012.07.031

来源: Elsevier

【 摘 要 】

Objectives The purpose of the present study was to test the potential of colchicine, an agent with potent anti-inflammatory action, to reduce atrial fibrillation (AF) recurrence after pulmonary vein isolation in patients with paroxysmal AF. Background Proinflammatory processes induced by AF ablation therapy have been implicated in postablation arrhythmia recurrence. Methods Patients with paroxysmal AF who received radiofrequency ablation treatment were randomized to a 3-month course of colchicine 0.5 mg twice daily or placebo. C-reactive protein (CRP) and interleukin (IL)-6 levels were measured on day 1 and on day 4 of treatment. Results In the 3-month follow-up, recurrence of AF was observed in 27 (33.5%) of 80 patients of the placebo group versus 13 (16%) of 81 patients who received colchicine (odds ratio: 0.38, 95% confidence interval: 0.18 to 0.80). Gastrointestinal side-effects were the most common symptom among patients receiving active treatment. Diarrhea was reported in 7 patients in the colchicine group (8.6%) versus 1 in the placebo group (1.3%, p = 0.03). Colchicine led to higher reductions in CRP and IL-6 levels: the median difference of CRP and IL-6 levels between days 4 and 1 was -0.46 mg/l (interquartile range: -0.78 to 0.08 mg/l) and -0.10 mg/l (-0.30 to 0.10 pg/ml), respectively, in the placebo group versus -1.18 mg/l (-2.35 to -0.46 mg/l) and -0.50 pg/ml (-1.15 to -0.10 pg/ml) in the colchicine group (p < 0.01 for both comparisons). Conclusions Colchicine is an effective and safe treatment for prevention of early AF recurrences after pulmonary vein isolation in the absence of antiarrhythmic drug treatment. This effect seems to be associated strongly with a significant decrease in inflammatory mediators, including IL-6 and CRP. (J Am Coll Cardiol 2012;60:1790-6) (C) 2012 by the American College of Cardiology Foundation

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