Effect of low dose colchicine on long term recurrence after atrial fibrillation ablation

Background: Colchicine is commonly used early after atrial fibrillation (AF) ablation to reduce inflammation and reduce AF recurrence, but there is limited long-term efficacy data. Objective: To evaluate the effect of low dose colchicine use on long-term AF recurrence after AF ablation. Methods: From 2013 to 2021, all AF ablations performed at a single tertiary care medical center were analyzed for colchicine use, clinical and procedural characteristics, and AF recurrence. The colchicine dose was 0.3-0.6 mg once daily for 30 days. The primary outcome was AF recurrence, defined as AF detection for more than 30 s after a three-month blanking period. Propensity score matching (PSM, 1:1 match) was performed using covariates that were significant predictors of AF recurrence in prior studies. The minimum duration of follow-up was 6 months. Kaplan-Meier analysis was conducted to assess time to AF recurrence in the entire cohort and the PSM cohort. Results: The study population consisted of 1568 AF ablations in 1412 patients (67 % male, age 65 +/- 7 years and mean follow up 34 +/- 14 months); 78 % of the patients received colchicine. Colchicine use was associated with decreased AF recurrence (HR 0.78, CI 0.63-0.96, p = 0.022). After PSM there were 275 patients in each group. AF recurrence was lower with colchicine (HR 0.71, CI 0.53-0.96, p = 0.026). Conclusions: Low dose colchicine use was associated with lower long-term AF recurrence after AF ablation. A randomized, placebo-controlled trial is warranted to confirm if low dose colchicine should be used routinely after AF ablation.