秋水仙碱预防心房颤动导管消融术后心房颤动复发及心包炎的疗效——前瞻性研究的系统评价和荟萃分析
The efficacy of colchicine in preventing atrial fibrillation recurrence and pericarditis post-catheter ablation for atrial fibrillation - A systematic review and meta-analysis of prospective studies.
作者信息
Borra Vamsikalyan, Mahadevan Arankesh, Gautam Senapati Sidhartha, Vempati Roopeessh, Jaiswal Vikash, Borra Nithya, Ahmad Javaria, Rodrigo Zamudio Herrera Oscar, Vergara Sanchez Carlos, Prasad Tanisha, Thachil Rosy, Ganatra Sarju, Dani Sourbha
机构信息
Department of Internal Medicine, The University of Texas Rio Grande Valley, Edinburg, TX, USA.
Department of Internal Medicine, SRM Medical College Hospital and Research Centre, Tamil Nadu, India.
出版信息
Int J Cardiol Heart Vasc. 2024 Jul 25;53:101466. doi: 10.1016/j.ijcha.2024.101466. eCollection 2024 Aug.
INTRODUCTION
Catheter ablation (CA) initiates a proinflammatory process responsible for atrial fibrillation (AF) recurrence (25-40%) and pericarditis (0.8%). Due to its anti-inflammatory properties, colchicine, a microtubule inhibitor, is explored for the prevention of early AF recurrence and pericarditis after pulmonary vein isolation. We performed a pooled analysis to determine the rates of AF recurrence and pericarditis after CA in patients receiving colchicine.
METHODS
A comprehensive literature review was conducted on PubMed and SCOPUS from inception to December 2023 using medical subject headings and keywords, followed by a citation and reference search. We identified prospective studies reporting recurrent AF and pericarditis outcomes after catheter ablation in patients taking colchicine versus placebo. A binary random effects model was used to estimate pooled odds ratios and 95% confidence intervals. Sensitivity analysis was conducted using the leave-one-out method, and heterogeneity was assessed using the statistic.
RESULTS
Of the 958 identified studies, 4 met our inclusion criteria. A total of 1,619 patients were analyzed; 743 received colchicine, and 875 were in the placebo group. Recurrent AF after CA occurred in 192 (29.0 %) of the colchicine group and 318 (39.5 %) of the placebo group. Post-ablation pericarditis occurred in 34 (5.3 %) of the colchicine group and 128 (16.5 %) of the placebo group. Pooled analysis of prospective studies showed that colchicine decreased the odds of recurrent AF [OR: 0.63 (95 % CI: 0.50-0.78), p < 0.01, = 8 %] and post-ablation pericarditis [OR: 0.34 (95 % CI: 0.16-0.75), p < 0.01, = 57 %]. Odds of GI disturbance were increased with colchicine use in our analysis [OR: 2.77 (95 % CI: 1.17-6.56), p = 0.02, = 84 %].
CONCLUSION
Colchicine use is associated with decreased odds of recurrent AF and pericarditis post-CA from the analysis of prospective studies. These results underscore the potential for colchicine therapy for future exploration with randomized and controlled research with different dosages.
引言
导管消融（CA）引发了一个促炎过程，这一过程是房颤（AF）复发（25%-40%）和心包炎（0.8%）的原因。秋水仙碱作为一种微管抑制剂，因其抗炎特性，被用于探索预防肺静脉隔离术后早期房颤复发和心包炎。我们进行了一项汇总分析，以确定接受秋水仙碱治疗的患者在CA术后房颤复发和心包炎的发生率。
方法
从创刊至2023年12月，在PubMed和SCOPUS上使用医学主题词和关键词进行了全面的文献综述，随后进行了引文和参考文献搜索。我们确定了前瞻性研究，报告了服用秋水仙碱与安慰剂的患者在导管消融术后房颤复发和心包炎的结果。使用二元随机效应模型来估计汇总比值比和95%置信区间。采用留一法进行敏感性分析，并使用统计量评估异质性。
结果
在958项已识别的研究中，4项符合我们的纳入标准。共分析了1619例患者；743例接受秋水仙碱治疗，875例在安慰剂组。CA术后房颤复发在秋水仙碱组为192例（29.0%），在安慰剂组为318例（39.5%）。消融后心包炎在秋水仙碱组为34例（5.3%），在安慰剂组为128例（16.5%）。前瞻性研究的汇总分析表明，秋水仙碱降低了房颤复发的几率[比值比：0.63（95%置信区间：0.50-0.78），p<0.01，异质性=8%]和消融后心包炎的几率[比值比：0.34（95%置信区间：0.16-0.75），p<0.01，异质性=57%]。在我们的分析中，使用秋水仙碱会增加胃肠道不适的几率[比值比：2.77（95%置信区间：1.17-6.56），p=0.02，异质性=84%]。
结论
根据前瞻性研究分析，使用秋水仙碱与CA术后房颤复发和心包炎几率降低相关。这些结果强调了秋水仙碱疗法在未来进行不同剂量的随机对照研究探索中的潜力。
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