Mohsin Salih1, Aiman Smer2, Richard Charnigo3, Mohamed Ayan4, Yousef H Darrat5, Mahmoud Traina6, Gustavo X Morales5, Luigi DiBiase7, Andrea Natale7, Claude S Elayi5. 1. University of Kentucky, Department of Internal Medicine, Lexington, KY, United States. Electronic address: mohsin.salih@uky.edu. 2. Creighton University School of Medicine, Department of Cardiovascular Medicine, Omaha, NE, United States. 3. University of Kentucky, Departments of Biostatistics and Statistics, Lexington, KY, United States. 4. University of Arkansas Medical Science, Department of Cardiovascular Medicine, Little Rock, AR, United States. 5. University of Kentucky, Gill Heart Institute and VAMC, Department of Cardiovascular Medicine, Lexington, KY, United States. 6. Cleveland Clinic Abu Dhabi, Department of Cardiovascular Medicine, Abu Dhabi, United Arab Emirates. 7. Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, TX, United States.
Abstract
BACKGROUND: Development of atrial fibrillation after certain cardiac procedures is a common medical problem. The inflammatory process plays an important role in the pathogenesis of post-cardiac procedure atrial fibrillation (PCP-AF). Colchicine, a potent anti-inflammatory agent, has been used in several studies to reduce the risk of PCP-AF. This meta-analysis of randomized controlled trials (RCTs) was conducted to assess the efficacy of colchicine in prevention of PC-PAF. METHODS: We searched PubMed, EMBASE, Web of Science, Cochrane Library database and Google Scholar for RCTs, using terms "Atrial fibrillation, atrial, or fibrillation and colchicine". The primary end-point was the occurrence of AF post cardiac procedure, which includes cardiac surgery or pulmonary vein isolation. The safety end point was the occurrence of any side effects. Estimated odds ratios (OR) and 95% confidence intervals (CI) were evaluated. RESULTS: A total of six RCTs were included in this meta-analysis, enrolling a total of 1257 patients. Colchicine significantly reduced the odds of PCP-AF (OR 0.52; 95% CI, 0.40-0.68, P<0.001, I2=0%). However, occurrence of side effects was significantly higher with colchicine when compared to placebo (OR 2.10; 95% CI, 1.34-3.30, P<0.001, I2=0%). The number needed to treat is 7 and the number needed to harm is 11.2. The proportion of patients discontinuing treatment was 16%. CONCLUSION: This meta-analysis shows that colchicine is an effective drug for prevention of PCP-AF. Colchicine could be considered as a prophylaxis to reduce PCP-AF, with some risk of treatment discontinuation due to the poor gastrointestinal tolerance (diarrhea).
BACKGROUND: Development of atrial fibrillation after certain cardiac procedures is a common medical problem. The inflammatory process plays an important role in the pathogenesis of post-cardiac procedure atrial fibrillation (PCP-AF). Colchicine, a potent anti-inflammatory agent, has been used in several studies to reduce the risk of PCP-AF. This meta-analysis of randomized controlled trials (RCTs) was conducted to assess the efficacy of colchicine in prevention of PC-PAF. METHODS: We searched PubMed, EMBASE, Web of Science, Cochrane Library database and Google Scholar for RCTs, using terms "Atrial fibrillation, atrial, or fibrillation and colchicine". The primary end-point was the occurrence of AF post cardiac procedure, which includes cardiac surgery or pulmonary vein isolation. The safety end point was the occurrence of any side effects. Estimated odds ratios (OR) and 95% confidence intervals (CI) were evaluated. RESULTS: A total of six RCTs were included in this meta-analysis, enrolling a total of 1257 patients. Colchicine significantly reduced the odds of PCP-AF (OR 0.52; 95% CI, 0.40-0.68, P<0.001, I2=0%). However, occurrence of side effects was significantly higher with colchicine when compared to placebo (OR 2.10; 95% CI, 1.34-3.30, P<0.001, I2=0%). The number needed to treat is 7 and the number needed to harm is 11.2. The proportion of patients discontinuing treatment was 16%. CONCLUSION: This meta-analysis shows that colchicine is an effective drug for prevention of PCP-AF. Colchicine could be considered as a prophylaxis to reduce PCP-AF, with some risk of treatment discontinuation due to the poor gastrointestinal tolerance (diarrhea).
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