Jain Hritvik, Odat Ramez M, Dey Debankur, Singh Jagjot, Kaur Ramanjot, Jain Jyoti, Goyal Aman, Ahmed Mushood, Marsool Mohammed Dheyaa Marsool, Passey Siddhant, Gole Shrey
From the Department of Internal Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, India.
Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.
Cardiol Rev. 2024 Aug 28. doi: 10.1097/CRD.0000000000000769.
Catheter ablation for atrial fibrillation (AF) is a commonly performed procedure, however, post-ablation AF recurrence is often observed due to inflammation and oxidative stress. Colchicine is a potent anti-inflammatory agent with conflicting efficacy in preventing post-ablation AF recurrence. A comprehensive literature search of the major bibliographic databases was conducted to retrieve studies comparing colchicine use versus placebo in AF patients post-ablation. Odds ratios (ORs) with 95% confidence intervals (CIs) were pooled using the DerSimonian-Laird random-effects model. Statistical significance was set at P < 0.05. Six studies were included with 1791 patients (721 in the colchicine group and 1070 in the placebo group). Patients who received colchicine had significantly lower odds of AF recurrence on follow-up (OR, 0.62; 95% CI, 0.48-0.79; P = 0.0001) but had higher gastrointestinal side effects (OR, 2.67; 95% CI, 1.00-7.12; P = 0.05). There were no statistically significant differences in acute pericarditis (OR, 0.54; 95% CI, 0.27-1.05; P = 0.07) or hospitalization (OR, 1.03; 95% CI, 0.73-1.45; P = 0.87). Prophylactic use of colchicine after catheter ablation in patients with AF leads to a reduction in AF recurrence, albeit with increased gastrointestinal side effects. Colchicine use did not lead to a reduction in the rates of pericarditis and hospitalization after ablation. Large randomized controlled trials are necessary to evaluate the efficacy of colchicine in preventing AF recurrence, particularly focusing on the dose and duration of treatment to optimize the side effect profile.
导管消融治疗心房颤动（AF）是一种常见的手术，但由于炎症和氧化应激，消融术后房颤复发经常可见。秋水仙碱是一种强效抗炎药，在预防消融术后房颤复发方面疗效存在争议。我们对主要文献数据库进行了全面的文献检索，以检索比较房颤患者消融术后使用秋水仙碱与安慰剂的研究。使用DerSimonian-Laird随机效应模型汇总了具有95%置信区间（CI）的比值比（OR）。设定统计学显著性为P<0.05。纳入了6项研究，共1791例患者（秋水仙碱组721例，安慰剂组1070例）。接受秋水仙碱治疗的患者随访时房颤复发几率显著降低（OR，0.62；95%CI，0.48 - 0.79；P = 0.0001），但胃肠道副作用发生率较高（OR，2.67；95%CI，1.00 - 7.12；P = 0.05）。急性心包炎（OR，0.54；95%CI，0.27 - 1.05；P = 0.07）或住院率（OR，1.03；95%CI，0.73 - 1.45；P = 0.87）无统计学显著差异。对于房颤患者导管消融术后预防性使用秋水仙碱可降低房颤复发率，尽管胃肠道副作用会增加。使用秋水仙碱并未降低消融术后心包炎和住院率。有必要开展大型随机对照试验来评估秋水仙碱预防房颤复发的疗效，尤其要关注治疗剂量和疗程以优化副作用情况。
