Po-02-204 colchicine usage for prevention of post atrial fibrillation ablation pericarditis in patients undergoing high power short duration ablation

Radiofrequency ablation (RFA) for atrial fibrillation (AF) can be associated with up to 10% incidence of post-operative pericarditis, suspected to be more prevalent with the advent of high-power short duration (HPSD) ablation. This has led to widespread use of colchicine, an anti-inflammatory medication, for prevention of post-AF ablation pericarditis. However, the utility of preventative colchicine remains unproven. To evaluate the efficacy of a routine post-operative colchicine regimen for prevention of post-ablation pericarditis in patients (pts) undergoing HPSD ablation for AF. We retrospectively evaluated consecutive single-operator HPSD AF ablation procedures at our institution from June 2019 to July 2022. A colchicine protocol was introduced in June 2021 for prevention of post-ablation pericarditis. None of the pts before this date received preventative colchicine while all consecutive pts after this date received routine colchicine 0.6 mg twice daily for 14 days starting on the procedure day. Pts were divided into colchicine and non-colchicine groups (gps). We recorded the incidence of post ablation chest pain, emergency room (ER) visit for chest pain, pericardial effusion, pericardiocentesis, any ER visit, hospitalization, AF recurrence and cardioversion (CV) for AF within the first 30 days post-ablation. We also recorded colchicine-related side effects and medication compliance. Out of 225 consecutive procedures, 20 were excluded for lack of follow-up data, yielding 101 pts in the colchicine gp and 104 pts in the non-colchicine gp. Both gps were well-matched for demographic and procedural parameters (Table 1). There was no significant difference in post-ablation chest pain (9.9% vs 8.6%, p = 0.7), pericardial effusion (2.9% vs 0.9%, p = 0.1), ER visits (11.9% vs 12.5%, p = 0.2), 30-day hospitalization for AF recurrence (0.9% vs 0.96%,p = 0.3) and 30-day need for CV for AF (3.9 % vs 5.7%, p = 0.2) (Table 1). 15 pts had severe colchicine-related diarrhea, out of which 12 discontinued it prematurely (Figure 1). In this single-operator retrospective analysis, preventative colchicine was not associated with any significant reduction in the incidence of pericarditis, pericardial effusion, ER visits or AF recurrence within the first 30 days after HPSD ablation for AF. Colchicine usage was associated with significant diarrhea affecting patient compliance. Our findings argue against routine use of colchicine for prevention of post AF-ablation pericarditis.