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How to Reduce Post-Surgery A-Fib Inflammation?

A friend of mine (with no history of Atrial Fibrillation) recently had quintuple bypass surgery. Afterwards he developed A-Fib. Subsequently, he was then put on the dreaded drug amiodarone. This happens all too often.

Read why I write “dreaded”, see Amiodarone: Most Effective and Most Toxic

A-Fib Common After Heart Surgery

After cardiac procedures such as bypass, 20%-40% patients develop A-Fib. It’s quite a disturbing development for patients. So, in addition to trying to recover from the trauma of heart surgery, their heart is in Atrial Fibrillation which they didn’t have before the surgery.

For A-Fib patients seeking a catheter ablation, I often refer them to a Master Electrophysiologist (EP) who uses the medication, Colchicine, to reduce post-surgery inflammation especially in non-paroxysmal and older patients. (Colchicine suppresses protein complexes that are responsible for activation of inflammatory signaling in the body).

Historic Colchicine: Treatment for Pain and Swelling

One of oldest known medications, Colchicine is mentioned in ancient Egyptian documents (1550 bc) in which it’s described as a treatment for pain and swelling. It’s one of the few medications known from that time which is still being used today.

One of the best known biologically active compounds from ancient times.

In modern times, Colchicine (pronounced: kol’ chi seen) is primarily used to treat gout (which can be very painful) for its broad anti-inflammatory effects. During cardiac surgery, Colchicine is used to treat pericarditis, the swelling and irritation of the thin, saclike tissue surrounding your heart (pericardium).

Because it reduces inflammation, some EPs are now using Colchicine to treat A-Fib.

Colchicine and Cardiac Disease Research

Colchicine is being investigated to prevent and treat cardiovascular disease. Inflammation plays a key role in the development and propagation of a range of cardiac illnesses. Many of the inflammatory mechanisms that are targeted by colchicine play a role in the development of coronary artery disease.

Anti-inflammatory therapies such as colchicine have shown benefits in reducing recurrence of A-Fib after surgery or catheter ablation.

• In a meta-analysis of 6 randomized trials, colchicine was shown to significantly reduce post-cardiac procedure A-Fib compared to a placebo (Salih M. et al).

• In another study colchicine use was associated with a 49% relative risk reduction of MI (heart attack), stroke, and transient ischemic attack compared to patients who did not use colchicine, as well as a 73% relative risk reduction in all-cause mortality (Slobodnick, A. et al).

In patients who underwent pulmonary vein isolation, Colchicine has been shown to help prevent early recurrences of paroxysmal A-Fib.

• The Colchicine for the Prevention of the Postpericardiotomy Syndrome (COPPS) AF Substudy found that the administering of colchicine appears to be safe and efficacious in the reduction of postoperative AF, which could potentially halve the complication and reduce the time a patient stays in the hospital.

Research has shown that the administration of colchicine in patients who underwent pulmonary vein isolation helped to prevent early recurrences of paroxysmal AF. (Rosenthal, L.)

What This Means For A-Fib Patients

Blood test vial

C-reactive protein (CRP-hs) blood test measures inflammation.

Learn About Your Inflammation Level. Why? The higher your inflammation the more you are at risk of developing heart disease and recurrent A-Fib.

The most common way to measure inflammation is to do a blood test for C-reactive protein (hs-CRP), which is a marker of inflammation. Another method is to measure homocysteine levels to evaluate chronic inflammation.

When you have your regular physical examination by your family doctor, they will usually draw blood to measure your C-reactive protein (CRP-hs) which ought to be less than 2. (Mine was 0.7.)

If Undergoing Any Kind of Heart Surgery, does Your Surgeon have a plan to deal with A-Fib after your surgery? If you are scheduled for heart surgery (of any kind), check with your surgeon to see if they have a protocol or procedure to deal with A-Fib after surgery.

Don’t settle for generalities. If they can’t cite specific steps they are prepared to take, maybe you should get a second opinion. The last thing you want is for your heart to go into A-Fib while you’re trying to recover from the trauma of heart surgery. Surgeons can also administer medications before surgery to prevent patients from developing A-Fib after the surgery.

A Key to Fighting the Inflammation of Atrial Fibrillation?

Isn’t it amazing that a medication at least centuries old is now used to combat inflammation in A-Fib and cardiac disease? Could colchicine and other anti-inflammation treatments become the key to stopping A-Fib from developing in the first place?

(Thanks to Anne Richard for alerting us to this use of colchicine in A-Fib.)

References
• Slobodnick, A. et al. Update on colchicine, 2017. Rheumatology, Volume 57, Issue suppl_1, January 2018, Pages i4-i11. https://doi.org/10.1093/rheumatology/kex453

• Zhou, X. et al. Evidence for Inflammation as a Driver of Atrial Fibrillation. Frontiers in Cardiovascular Medicine, April 29, 2020. https://doi.org/10.3389/fcvm.2020.00062

• Salih, M. et al. Colchicine for prevention of post-cardiac procedure atrial fibrillation: Meta-analysis of randomized controlled trials. Int J Cardiol. 2017; Sept 15:243:258-262. doi: 10.1016/j.ijcard.2017.04.022.

• Rosenthal, L. et al. Medscape. When is colchicine indicated in the treatment of atrial fibrillation (Afib) (AF)? Nov 18, 2019 (update). https://www.medscape.com/answers/151066-4179/when-is-colchicine-indicated-in-the-treatment-of-atrial-fibrillation-afib-af

• Imazio M, et al, for the COPPS Investigators. Colchicine reduces postoperative atrial fibrillation: results of the Colchicine for the Prevention of the Postpericardiotomy Syndrome (COPPS) atrial fibrillation substudy. Circulation. 2011 Nov 22. 124 (21):2290-5. https://reference.medscape.com/medline/abstract/22090167

• O’Riordan M. Colchicine postablation reduces early AF recurrences. Heartwire from Medscape. October 4, 2012; Accessed: October 15, 2012. http://www.medscape.com/viewarticle/772079.

• Deftereos S, et al. Colchicine for prevention of early atrial fibrillation recurrence after pulmonary vein isolation: a randomized controlled study. J Am Coll Cardiol. 2012 Oct 30. 60 (18):1790-6. https://reference.medscape.com/medline/abstract/23040570  

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