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• W3140223871 abstract "Increasing evidence suggests that the “NACHT-LRR and PYD domain-containing protein 3” (NLRP3) inflammasome plays an important role in atherosclerotic cardiovascular disease (ASCVD). Recent preclinical evidence has suggested that the NLRP3 inflammasome may play a prominent role in the pathogenesis of atrial fibrillation (AF). As such, the therapies that have shown efficacy in reducing ASCVD events may also prove beneficial in AF. In this article, we review the findings that implicate the NLRP3 inflammasome in the pathogenesis of AF, discuss existing evidence behind the use of anti-inflammatory agents for AF, and discuss the future role that colchicine and other anti-inflammatory agents may play in the prevention and treatment of AF. Increasing evidence suggests that the “NACHT-LRR and PYD domain-containing protein 3” (NLRP3) inflammasome plays an important role in atherosclerotic cardiovascular disease (ASCVD). Recent preclinical evidence has suggested that the NLRP3 inflammasome may play a prominent role in the pathogenesis of atrial fibrillation (AF). As such, the therapies that have shown efficacy in reducing ASCVD events may also prove beneficial in AF. In this article, we review the findings that implicate the NLRP3 inflammasome in the pathogenesis of AF, discuss existing evidence behind the use of anti-inflammatory agents for AF, and discuss the future role that colchicine and other anti-inflammatory agents may play in the prevention and treatment of AF. Key Findings▪The NLRP3 inflammasome may play a prominent role in the pathogenesis of atrial fibrillation (AF).▪Anti-inflammatory therapies such as colchicine have shown benefits in reducing recurrence of AF after surgery or ablation.▪Future randomized controlled trials are necessary to determine the efficacy of colchicine therapy for primary prevention and treatment of AF. ▪The NLRP3 inflammasome may play a prominent role in the pathogenesis of atrial fibrillation (AF).▪Anti-inflammatory therapies such as colchicine have shown benefits in reducing recurrence of AF after surgery or ablation.▪Future randomized controlled trials are necessary to determine the efficacy of colchicine therapy for primary prevention and treatment of AF. Atrial fibrillation (AF), the most common arrhythmia worldwide, affects 2%–3% of the population and is associated with significant morbidity and mortality.1Chugh S.S. Rasmus H. Kumar N. et al.Worldwide epidemiology of atrial fibrillation.Circulation. 2014; 129: 837-847Crossref PubMed Scopus (2399) Google Scholar,2Schnabel R.B. Yin X. Gona P. et al.50 year trends in atrial fibrillation prevalence, incidence, risk factors, and mortality in the Framingham Heart Study: a cohort study.Lancet. 2015; 386: 154-162Abstract Full Text Full Text PDF PubMed Scopus (629) Google Scholar AF is commonly preceded by structural remodeling of the atrial myocardium, which predisposes to impaired electrical conduction.3Staerk L. Sherer J.A. Ko D. Benjamin E.J. Helm R.H. Atrial fibrillation: epidemiology, pathophysiology, and clinical outcomes.Circ Res. 2017; 120: 1501-1517Crossref PubMed Scopus (301) Google Scholar The genesis of AF begins with a focal trigger of ectopic firing that initiates a reentrant wave in a vulnerable atrial substrate. The onset of AF leads to further atrial remodeling, which facilitates maintenance and progression of AF from paroxysmal AF (pAF) to persistent and longstanding persistent AF.4Li N. Brundel B.J.J.M. Inflammasomes and proteostasis novel molecular mechanisms associated with atrial fibrillation.Circ Res. 2020; 127: 73-90Crossref PubMed Scopus (16) Google Scholar, 5Allessie M. Ausma J. Schotten U. Electrical, contractile and structural remodeling during atrial fibrillation.Cardiovasc Res. 2002; 54: 230-246Crossref PubMed Scopus (1076) Google Scholar, 6Nattel S. Burstein B. Dobrev D. Atrial remodeling and atrial fibrillation: mechanisms and implications.Circ Arrhythm Electrophysiol. 2008; 1: 62-73Crossref PubMed Scopus (720) Google Scholar, 7Nattel S. Heijman J. Zhou L. Dobrev D. Molecular basis of atrial fibrillation pathophysiology and therapy: a translational perspective.Circ Res. 2020; 127: 51-72Crossref PubMed Scopus (71) Google Scholar Many nonmodifiable and modifiable risk factors, such as age, sex, ion channel mutations, hypertension, diabetes, obesity, and obstructive sleep apnea, have been linked to the progression of AF.3Staerk L. Sherer J.A. Ko D. Benjamin E.J. Helm R.H. Atrial fibrillation: epidemiology, pathophysiology, and clinical outcomes.Circ Res. 2017; 120: 1501-1517Crossref PubMed Scopus (301) Google Scholar However, whether there is a common fundamental mechanism leading to clinical AF remains unknown.8Nattel S. Dobrev D. Controversies about atrial fibrillation mechanisms.Circ Res. 2017; 120: 1396-1398Crossref PubMed Scopus (48) Google Scholar Enhanced inflammatory signaling has been previously proposed as one potential link in the pathogenesis of AF.9Hu Y.-F. Chen Y.-J. Lin Y.-J. Chen S.-A. Inflammation and the pathogenesis of atrial fibrillation.Nat Rev Cardiol. 2015; 12: 230-243Crossref PubMed Scopus (383) Google Scholar The association between inflammation and AF was first noted over 20 years ago with the high incidence rate of postoperative AF (up to 50%) after cardiac surgery.10Deftereos S.G. Vrachatis D.A. Angelidis C. et al.The role of colchicine in treating postoperative and post-catheter ablation atrial fibrillation.Clin Ther. 2019; 41: 21-29Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar In studies of postoperative AF, elevated inflammatory markers such as interleukin-1β (IL-1β), IL-6, and C-reactive protein (CRP) temporally correlated with onset of AF. In addition, randomized controlled trials (RCTs) demonstrated that prophylactic anti-inflammatory therapies after cardiac surgery also reduced the risk of postoperative AF.11Ho K.M. Tan J.A. Benefits and risks of corticosteroid prophylaxis in adult cardiac surgery: a dose-response meta-analysis.Circulation. 2009; 119: 1853-1866Crossref PubMed Scopus (173) Google Scholar Additional prospective cohort studies also suggested that higher CRP levels predicted onset of nonsurgical AF and lone AF in the general population.9Hu Y.-F. Chen Y.-J. Lin Y.-J. Chen S.-A. Inflammation and the pathogenesis of atrial fibrillation.Nat Rev Cardiol. 2015; 12: 230-243Crossref PubMed Scopus (383) Google Scholar However, Mendelian randomization studies of patients with increased CRP levels as a result of genetic polymorphisms did not increase the incidence of AF, suggesting that CRP levels were a marker of increased risk but did not play a pathophysiological role in the genesis of AF.12Marott S.C.W. Nordestgaard B.G. Zacho J. et al.Does elevated C-reactive protein increase atrial fibrillation risk? A Mendelian randomization of 47,000 individuals from the general population.J Am Coll Cardiol. 2010; 56: 789-795Crossref PubMed Scopus (99) Google Scholar As such, it remained unclear if inflammatory processes precipitated AF or were simply a marker of increased risk. A recent study by Yao and colleagues13Yao C. Veleva T. Scott L. et al.Enhanced cardiomyocyte NLRP3 inflammasome signaling promotes atrial fibrillation.Circulation. 2018; 138: 2227-2242Crossref PubMed Scopus (163) Google Scholar suggests that the “NACHT-LRR and PYD domain-containing protein 3” (NLRP3) inflammasome may play a causal role in the pathogenesis of AF. In this article, we review the findings from this study, discuss the evidence behind the use of anti-inflammatory agents for AF, and discuss the future role that colchicine may play in the prevention and treatment of AF. Inflammasomes are intracellular protein complexes that are responsible for activation of inflammatory signaling.14Swanson K.V. Deng M. Ting J.P.-Y. The NLRP3 inflammasome: molecular activation and regulation to therapeutics.Nat Rev Immunol. 2019; 19: 477-489Crossref PubMed Scopus (895) Google Scholar They form in response to cellular detection of a broad range of signals including microbial motifs, danger signals, environmental irritants, etc, and serve as a first line of defense against pathogens.4Li N. Brundel B.J.J.M. Inflammasomes and proteostasis novel molecular mechanisms associated with atrial fibrillation.Circ Res. 2020; 127: 73-90Crossref PubMed Scopus (16) Google Scholar NLRP3 is a type of inflammasome that has been noted in numerous cell types including immune cells, epithelial cells, and cardiomyocytes. Activation of the NLRP3 inflammasome causes the release of cytokines such as IL-1β and IL-18, which leads to a cascade of downstream inflammatory signaling, resulting in the increase of IL-6. An increase in high-sensitivity C-reactive protein (hs-CRP), a biomarker of inflammation, has also been shown to occur with inflammasome activation. IL-6 and hs-CRP have been shown to independently predict future cardiovascular events4Li N. Brundel B.J.J.M. Inflammasomes and proteostasis novel molecular mechanisms associated with atrial fibrillation.Circ Res. 2020; 127: 73-90Crossref PubMed Scopus (16) Google Scholar,15Abbate A. Toldo S. Marchetti C. Kron J. Van Tassell B.W. Dinarello C.A. Interleukin-1 and the inflammasome as therapeutic targets in cardiovascular disease.Circ Res. 2020; 126: 1260-1280Crossref PubMed Scopus (102) Google Scholar (Figure 1). The study by Yao and colleagues demonstrated that NLRP3 inflammasomes are enhanced in atrial cardiomyocytes of experimental models of AF, which promotes both the ectopic firing necessary to initiate AF and the remodeling of substrate needed to maintain and promote AF.4Li N. Brundel B.J.J.M. Inflammasomes and proteostasis novel molecular mechanisms associated with atrial fibrillation.Circ Res. 2020; 127: 73-90Crossref PubMed Scopus (16) Google Scholar,13Yao C. Veleva T. Scott L. et al.Enhanced cardiomyocyte NLRP3 inflammasome signaling promotes atrial fibrillation.Circulation. 2018; 138: 2227-2242Crossref PubMed Scopus (163) Google Scholar In mouse models with constitutively active NLRP3 within cardiomyocytes, NLRP3 activation resulted in increased ectopic firing as a result of enhanced sarcoplasmic reticulum calcium release. It also led to electrical remodeling via transcriptional modifications that promoted a shortened atrial effective refractory period, thereby creating a reentry substrate. In addition, the enhanced inflammatory signaling resulted in activation of inflammatory cells that promote atrial fibrosis, thereby leading to the development of AF-maintaining substrate. The use of novel NLRP3 inhibitors or ablation of NLRP3 in the mouse models prevented the development of AF, supporting a causal link between NLRP3 activation within cardiomyocytes and AF. This study is consistent with prior results that have shown that inflammatory markers such as IL-6 and IL-1β, which are downstream signaling cytokines of NLRP3 inflammasome activation, correlate with progression of AF and also freedom from recurrence after AF ablation4Li N. Brundel B.J.J.M. Inflammasomes and proteostasis novel molecular mechanisms associated with atrial fibrillation.Circ Res. 2020; 127: 73-90Crossref PubMed Scopus (16) Google Scholar (Figure 1). Recent clinical trials have demonstrated the importance of targeting the NLRP3 inflammasome pathway in reducing future atherosclerotic cardiovascular disease (ASCVD) events. The Canakinumab Anti-Inflammatory Thrombosis Outcomes Study (CANTOS) demonstrated that canakinumab, a monoclonal antibody against IL-1β, when given to patients with elevated hsCRP (≥2 mg/L) following a myocardial infarction, resulted in a 7%–15% reduction of cardiovascular events.16Ridker P.M. Everett B.M. Thuren T. et al.Antiinflammatory therapy with canakinumab for atherosclerotic disease.N Engl J Med. 2017; 377: 1119-1131Crossref PubMed Scopus (3512) Google Scholar However, the high cost and adverse side effect profile of canakinumab resulted in exploration of alternative anti-inflammatory agents such as colchicine. Colchicine is an inexpensive anti-inflammatory medication that is commonly used for the treatment of gout and pericarditis.17Nidorf S.M. Fiolet A.T.L. Mosterd A. et al.Colchicine in patients with chronic coronary disease.N Engl J Med. 2020; 383: 1838-1847Crossref PubMed Scopus (284) Google Scholar Colchicine works by inhibiting tubulin polymerization and has also been shown to interfere with the NLRP3/ IL-1β signaling pathway.17Nidorf S.M. Fiolet A.T.L. Mosterd A. et al.Colchicine in patients with chronic coronary disease.N Engl J Med. 2020; 383: 1838-1847Crossref PubMed Scopus (284) Google Scholar The 2013 Low Dose Colchicine (LoDoCo) trial, the Colchicine Cardiovascular Outcomes (COLCOT) trial, and the LoDoCo 2 trial have demonstrated that treatment with colchicine for secondary prevention resulted in a reduction in future ASCVD events.17Nidorf S.M. Fiolet A.T.L. Mosterd A. et al.Colchicine in patients with chronic coronary disease.N Engl J Med. 2020; 383: 1838-1847Crossref PubMed Scopus (284) Google Scholar, 18Nidorf S.M. Eikelboom J.W. Budgeon C.A. Thompson P.L. Low-dose colchicine for secondary prevention of cardiovascular disease.J Am Coll Cardiol. 2013; 61: 404-410Crossref PubMed Scopus (460) Google Scholar, 19Tardif J.-C. Kouz S. Waters D.D. et al.Efficacy and safety of low-dose colchicine after myocardial infarction.N Engl J Med. 2019; 381: 2497-2505Crossref PubMed Scopus (689) Google Scholar Given the role of the NLRP3 inflammasome in both ASCVD and AF, we review the current evidence evaluating the role of anti-inflammatory therapies for treatment and prevention of AF. Currently, therapeutic strategies seek to minimize symptoms and avoid the complications associated with AF. Even procedural options such as ablation and cardioversion are complicated by high recurrence rates.3Staerk L. Sherer J.A. Ko D. Benjamin E.J. Helm R.H. Atrial fibrillation: epidemiology, pathophysiology, and clinical outcomes.Circ Res. 2017; 120: 1501-1517Crossref PubMed Scopus (301) Google Scholar,4Li N. Brundel B.J.J.M. Inflammasomes and proteostasis novel molecular mechanisms associated with atrial fibrillation.Circ Res. 2020; 127: 73-90Crossref PubMed Scopus (16) Google Scholar However, current approaches do not target the potential key inflammatory mediators in the pathogenesis of AF. Although anti-inflammatory therapies such as canakinumab, colchicine, and steroids have shown ability to attenuate NLRP3-mediated inflammation, studies evaluating their role in the treatment and prevention of AF are limited20Martínez G.J. Celermajer D.S. Patel S. The NLRP3 inflammasome and the emerging role of colchicine to inhibit atherosclerosis-associated inflammation.Atherosclerosis. 2018; 269: 262-271Abstract Full Text Full Text PDF PubMed Scopus (98) Google Scholar (Table 1, Figure 2).Table 1Outcomes of atrial fibrillation recurrence with anti-inflammatory therapiesStudyStudy typeSample sizeInterventionPrimary endpointMedian follow-upEffect estimate (95% CI)DeductionAF with canakinumab following cardioversion Krisai et al, 2020Randomized controlled trial24CanakinumabAF recurrence at 6 months6 monthsHR: 0.36 (0.11; 1.15)NeutralAF with colchicine following surgery Imazio et al, 2011 (COPPS)Randomized controlled trial336ColchicinePost-op AF at 1 month1 monthRR: 0.56 (0.34; 0.93)Positive Imazio et al, 2014 (COPPS-2)Randomized controlled trial360ColchicinePost-op AF within 3 months3 monthsRR: 0.81 (0.62; 1.06)Neutral Tabbalat et al, 2016Randomized controlled trial360ColchicinePost-op AF after 1 week8 daysRR: 0.71 (0.45; 1.12)Neutral Zarpelon et al, 2016Randomized controlled trial140ColchicinePost-op AF after 2 weeks14 daysRR: 0.54 (0.19; 1.53)NeutralAF with corticosteroids following PVI/ablation Koyoma et al, 2010Randomized controlled trial125Hydrocortisone and prednisoloneAF recurrence at 14 months14 monthsHR: 0.45 (0.23; 0.93)Positive Won et al, 2013Prospective cohort study89Low-dose hydrocortisoneAF recurrence at 12 months12 monthsRR: 0.65 (0.36; 1.20)Neutral Kim YR et al, 2015Randomized controlled trial138MethylprednisoloneAF recurrence at 3 monthsAF recurrence at 24 months3 months24 monthsRR: 0.57 (0.35; 0.93) RR: 1.09(0.69; 1.74)PositiveNeutral Kim DR et al, 2015Randomized controlled trial407Hydrocortisone and methylprednisoloneAF recurrence at 12 months12 monthsRR: 0.92 (0.58; 1.45)Neutral Iskandar et al, 2017Randomized controlled trial60PrednisoneAF recurrence at 12 months12 monthsRR: 1.33 (0.66; 2.69)NeutralAF with colchicine following PVI/ablation Deftereos et al, 2012Randomized controlled trial170ColchicineAF recurrence at 3 months3 monthsRR: 0.47 (0.27; 0.85)Positive Egami et al, 2013 (Abstract)Randomized controlled trial62ColchicineAF recurrence at 2 weeksAF recurrence at 2 months2 weeks2 monthsRR: 0.43 (0.19; 0.95) RR: 1.07(0.23; 4.87)Positive Neutral Deftereos et al, 2014Randomized controlled trial206ColchicineAF recurrence at 12 months12 monthsRR: 0.63 (0.44; 0.89)Positive Egami et al, 2015 (Abstract)Prospective cohort study122ColchicineAF recurrence at 12 months12 monthsRR: 0.28 (0.11; 0.75)PositiveAF = atrial fibrillation; CI = confidence interval; HR = hazard ratio; Post-op = postoperative; PVI = pulmonary vein isolation; RR = relative risk. Open table in a new tab AF = atrial fibrillation; CI = confidence interval; HR = hazard ratio; Post-op = postoperative; PVI = pulmonary vein isolation; RR = relative risk. Krisai and colleagues21Krisai P. Blum S. Schnabel R.B. et al.Canakinumab after electrical cardioversion in patients with persistent atrial fibrillation.Circ Arrhythm Electrophysiol. 2020; 13e008197Crossref PubMed Scopus (1) Google Scholar evaluated the use of canakinumab after electrical cardioversion in 24 patients with persistent AF. After achieving sinus rhythm, patients treated with canakinumab vs placebo were followed to determine recurrence rate of AF after 6 months. Although there was a lower incidence of AF recurrence, the results were not statistically significant; the small sample size, however, was a significant limitation.21Krisai P. Blum S. Schnabel R.B. et al.Canakinumab after electrical cardioversion in patients with persistent atrial fibrillation.Circ Arrhythm Electrophysiol. 2020; 13e008197Crossref PubMed Scopus (1) Google Scholar Several RCTs have evaluated the role of colchicine for prevention of post–cardiothoracic surgery AF.10Deftereos S.G. Vrachatis D.A. Angelidis C. et al.The role of colchicine in treating postoperative and post-catheter ablation atrial fibrillation.Clin Ther. 2019; 41: 21-29Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar The Colchicine for the Prevention of the Postcardiotomy Syndrome (COPPS) Atrial Fibrillation Substudy showed a reduced incidence of pAF in patients treated with colchicine for 1 month after pericardiotomy. A follow-up trial (COPPS-2) was conducted to evaluate patients undergoing any cardiac surgery except cardiac transplantation. Although the on-treatment subanalysis revealed a beneficial effect of colchicine for AF, this was not statistically significant based on an intention-to-treat analysis. Other studies have noted no benefit with colchicine in post-revascularization surgeries or in other open heart surgery patients.22Zarpelon C.S. Netto M.C. Jorge J.C.M. et al.Colchicine to reduce atrial fibrillation in the postoperative period of myocardial revascularization.Arq Bras Cardiol. 2016; 107: 4-9PubMed Google Scholar,23Tabbalat R.A. Hamad N.M. Alhaddad I.A. Hammoudeh A. Akasheh B.F. Khader Y. Effect of ColchiciNe on the InciDence of Atrial Fibrillation in Open Heart Surgery Patients: END-AF Trial.Am Heart J. 2016; 178: 102-107Crossref PubMed Scopus (22) Google Scholar Patients who undergo AF ablation are known to have high levels of endocardial inflammation, including elevated IL-6 and hsCRP, in the first 3 months following the procedure, which may be associated with the 40%–50% rate of early and late AF recurrence.24Issac T.T. Dokainish H. Lakkis N.M. Role of inflammation in initiation and perpetuation of atrial fibrillation.J Am Coll Cardiol. 2007; 50: 2021-2028Crossref PubMed Scopus (409) Google Scholar,25De Vecchis R. Promising effects of moderate-dose corticosteroid therapy in the blanking period for prevention of atrial fibrillation (AF) recurrences in patients undergoing AF ablation.Eur J Clin Pharmacol. 2019; 75: 1179-1180Crossref PubMed Scopus (0) Google Scholar As such, several studies have evaluated the role of anti-inflammatory therapies such as colchicine or steroids after pulmonary vein isolation (PVI) and AF ablation to prevent recurrence of AF.10Deftereos S.G. Vrachatis D.A. Angelidis C. et al.The role of colchicine in treating postoperative and post-catheter ablation atrial fibrillation.Clin Ther. 2019; 41: 21-29Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar,25De Vecchis R. Promising effects of moderate-dose corticosteroid therapy in the blanking period for prevention of atrial fibrillation (AF) recurrences in patients undergoing AF ablation.Eur J Clin Pharmacol. 2019; 75: 1179-1180Crossref PubMed Scopus (0) Google Scholar The results with steroids have been inconsistent. In a small RCT by Koyama and colleagues26Koyama T. Tada H. Sekiguchi Y. et al.Prevention of atrial fibrillation recurrence with corticosteroids after radiofrequency catheter ablation: a randomized controlled trial.J Am Coll Cardiol. 2010; 56: 1463-1472Crossref PubMed Scopus (124) Google Scholar including 125 patients undergoing PVI and ablation, the use of hydrocortisone on the day of AF ablation and prednisolone for 3 days after resulted in the decrease in immediate and late recurrence of AF. However, a similar study by Kim and colleagues27Kim Y.R. Nam G.-B. Han S. et al.Effect of short-term steroid therapy on early recurrence during the blanking period after catheter ablation of atrial fibrillation.Circ Arrhythm Electrophysiol. 2015; 8: 1366-1372Crossref PubMed Scopus (28) Google Scholar using methylprednisolone showed there was a decrease in early recurrence rates, but no difference in late recurrence rates at the 24-month follow-up. In the prospective, randomized, double-blinded Steroid-AF Study, 60 patients who failed antiarrhythmic therapy were randomized to prednisone or placebo after ablation for pAF.28Iskandar S. Reddy M. Afzal M.R. et al.Use of oral steroid and its effects on atrial fibrillation recurrence and inflammatory cytokines post ablation - The Steroid AF Study.J Atr Fibrillation. 2017; 9: 1604Crossref PubMed Scopus (12) Google Scholar Prednisone did not reduce early or late recurrence of AF, and in fact, there was a trend towards higher rates of early AF recurrence with prednisone use. Two studies that evaluated the efficacy of a single-dose steroid injection after AF ablations did not show any benefit in preventing AF recurrence.29Kim D.-R. Won H. Uhm J.-S. et al.Comparison of two different doses of single bolus steroid injection to prevent atrial fibrillation recurrence after radiofrequency catheter ablation.Yonsei Med J. 2015; 56: 324-331Crossref PubMed Scopus (17) Google Scholar,30Won H. Kim J.-Y. Shim J. et al.Effect of a single bolus injection of low-dose hydrocortisone for prevention of atrial fibrillation recurrence after radiofrequency catheter ablation.Circ J. 2013; 77: 53-59Crossref PubMed Scopus (18) Google Scholar In 2012, Deftereos and colleagues31Deftereos S. Giannopoulos G. Kossyvakis C. et al.Colchicine for prevention of early atrial fibrillation recurrence after pulmonary vein isolation: a randomized controlled study.J Am Coll Cardiol. 2012; 60: 1790-1796Crossref PubMed Scopus (165) Google Scholar conducted the first study evaluating the efficacy of colchicine therapy after PVI and AF ablation in preventing AF recurrence. In this double-blinded placebo-controlled RCT, 161 patients undergoing ablation for pAF were treated with colchicine for 3 months after the procedure. Treatment with colchicine significantly reduced incidence of AF recurrence (16% vs 33.5%, P = .01).31Deftereos S. Giannopoulos G. Kossyvakis C. et al.Colchicine for prevention of early atrial fibrillation recurrence after pulmonary vein isolation: a randomized controlled study.J Am Coll Cardiol. 2012; 60: 1790-1796Crossref PubMed Scopus (165) Google Scholar A follow up study by Deftereos and colleagues32Deftereos S. Giannopoulos G. Efremidis M. et al.Colchicine for prevention of atrial fibrillation recurrence after pulmonary vein isolation: mid-term efficacy and effect on quality of life.Heart Rhythm. 2014; 11: 620-628Abstract Full Text Full Text PDF PubMed Scopus (69) Google Scholar including patients who underwent ablation and treatment with colchicine for 3 months showed similar long-term reduction in AF recurrence rates at the 15-month follow-up (31% vs 50%, P = .01). In a 2013 prospective study, colchicine was effective at preventing AF recurrences within 2 weeks after ablation, but the effect was no longer present between 2 weeks and 2 months postablation.33Egami Y. Nishino M. Kato T. et al.Impact of short duration colchicine use on reduction of immediate atrial fibrillation after catheter ablation: prospective study.J Am Coll Cardiol. 2013; 61 (E408–E408)Crossref Google Scholar Several combined meta-analyses including postsurgical and postablation patients have evaluated the role of colchicine for preventing recurrence of AF after ablation, with 5 out of 6 meta-analyses suggesting a protective role of colchicine, whereas only 1 study was neutral.34Salih M. Smer A. Charnigo R. et al.Colchicine for prevention of post-cardiac procedure atrial fibrillation: meta-analysis of randomized controlled trials.Int J Cardiol. 2017; 243: 258-262Abstract Full Text Full Text PDF PubMed Scopus (19) Google Scholar, 35Papageorgiou N. Briasoulis A. Lazaros G. Imazio M. Tousoulis D. Colchicine for prevention and treatment of cardiac diseases: a meta-analysis.Cardiovasc Ther. 2017; 35: 10-18Crossref PubMed Scopus (30) Google Scholar, 36Verma S. Eikelboom J.W. Nidorf S.M. et al.Colchicine in cardiac disease: a systematic review and meta-analysis of randomized controlled trials.BMC Cardiovasc Disord. 2015; 15: 96Crossref PubMed Scopus (80) Google Scholar, 37Lennerz C. Barman M. Tantawy M. Sopher M. Whittaker P. Colchicine for primary prevention of atrial fibrillation after open-heart surgery: systematic review and meta-analysis.Int J Cardiol. 2017; 249: 127-137Abstract Full Text Full Text PDF PubMed Scopus (43) Google Scholar, 38Trivedi C. Sadadia M. Colchicine in prevention of atrial fibrillation following cardiac surgery: systematic review and meta-analysis.Indian J Pharmacol. 2014; 46: 590-595Crossref PubMed Scopus (14) Google Scholar, 39Wang M.-X. Deng X.-L. Mu B.-Y. et al.Effect of colchicine in prevention of pericardial effusion and atrial fibrillation: a meta-analysis.Intern Emerg Med. 2016; 11: 867-876Crossref PubMed Scopus (8) Google Scholar To better understand the variable effect of colchicine for AF recurrence prevention, 122 patients with preprocedure computed tomography imaging undergoing AF ablation and treatment with colchicine were evaluated.40Egami Y. Nishino M. Shutta R. Makino N. Tanouchi J. Abstract 12012: relation between colchicine and epicardial adipose tissue volume surrounding left atrium in atrial fibrillation recurrence after ablation.Circulation. 2015; 132 (A12012–A12012)Google Scholar The evaluation identified that patients with larger left atrial epicardial adipose tissue (LA-EAT) volumes were more likely to benefit from colchicine therapy than those who had smaller LA-EAT.40Egami Y. Nishino M. Shutta R. Makino N. Tanouchi J. Abstract 12012: relation between colchicine and epicardial adipose tissue volume surrounding left atrium in atrial fibrillation recurrence after ablation.Circulation. 2015; 132 (A12012–A12012)Google Scholar, 41Ciuffo L. Nguyen H. Marques M.D. et al.Periatrial fat quality predicts atrial fibrillation ablation outcome.Circ Cardiovasc Imaging. 2019; 12e008764Crossref PubMed Scopus (7) Google Scholar, 42Sepehri Shamloo A. Dagres N. Dinov B. et al.Is epicardial fat tissue associated with atrial fibrillation recurrence after ablation? A systematic review and meta-analysis.Int J Cardiol Heart Vasc. 2019; 22: 132-138PubMed Google Scholar In addition, LA-EAT has been linked to LA arrhythmogenicity and may be helpful in distinguishing who may benefit from anti-inflammatory therapy after AF ablation.41Ciuffo L. Nguyen H. Marques M.D. et al.Periatrial fat quality predicts atrial fibrillation ablation outcome.Circ Cardiovasc Imaging. 2019; 12e008764Crossref PubMed Scopus (7) Google Scholar,42Sepehri Shamloo A. Dagres N. Dinov B. et al.Is epicardial fat tissue associated with atrial fibrillation recurrence after ablation? A systematic review and meta-analysis.Int J Cardiol Heart Vasc. 2019; 22: 132-138PubMed Google Scholar In the studies evaluating the use of anti-inflammatory therapies for postprocedure AF, the role of the NLRP3 inflammasome pathway remains unclear. Although the inflammatory markers that are elevated in postprocedure AF (IL-1β, IL-6, and CRP) are similar to those after NLRP3 inflammasome activation, future studies that demonstrate the role of the NLRP3 inflammasome in postprocedure AF are necessary. In addition, studies that evaluate the role of the NLRP3 inflammasome in nonsurgical AF are also necessary. Currently, the American College of Cardiology (ACC)/American Heart Association (AHA)/Heart and Rhythm Society (HRS) Guideline for the Management of AF gives a class IIb recommendation to treat individuals with colchicine after cardiac surgery to prevent AF.43January C.T. Samuel W.L. Hugh Calkins et al.2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society in Collaboration With the Society of Thoracic Surgeons.Circulation. 2019; 140: e125-e151Crossref PubMed Scopus (843) Google Scholar,44January C.T. Wann L.S. Alpert J.S. et al.2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society.Circulation. 2014; 130: 2071-2104Crossref PubMed Scopus (1338) Google Scholar Following data from Yao and colleagues13Yao C. Veleva T. Scott L. et al.Enhanced cardiomyocyte NLRP3 inflammasome signaling promotes atrial fibrillation.Circulation. 2018; 138: 2227-2242Crossref PubMed Scopus (163) Google Scholar linking the NLRP3 inflammasome to AF, and multiple cardiovascular outcome trials demonstrating a benefit with anti-inflammatory therapies for the secondary prevention of ASCVD, further investigation is required to determine a role for anti-inflammatory therapies for prevention and treatment of AF. Given the recent evidence from LoDoCo, COLCOT, and LoDoCo 2, colchicine could be considered for primary and secondary prevention of ASCVD.45Samuel M. Waters D.D. Will colchicine soon be part of primary and secondary cardiovascular prevention?.Can J Cardiol. 2020; 36: 1697-1699Abstract Full Text Full Text PDF PubMed Google Scholar High-quality RCTs are necessary to determine the efficacy of colchicine therapy for prevention and treatment of AF before it can receive a strong recommendation in future ACC/AHA and HRS guidelines. Colchicine and other anti-inflammatory agents that target the NLRP3 inflammasome pathway may prove to be a valuable tool in reducing overall AF burden and preventing progression of AF. However, given the overlap in risk factors for ASCVD and AF, addressing the modifiable risk factors will remain the cornerstone of therapy for prevention of AF." @default.
• W3140223871 created "2021-04-13" @default.
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• W3140223871 date "2021-06-01" @default.
• W3140223871 modified "2023-10-11" @default.
• W3140223871 title "Inflammation, atrial fibrillation, and the potential role for colchicine therapy" @default.
• W3140223871 cites W101847764 @default.
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