Po-02-068 real world colchicine use for prevention of pericarditis after ablation for atrial fibrillation

Colchicine is a commonly used anti-inflammatory medication for the treatment of acute pericarditis. The incidence of pericarditis after atrial fibrillation (AF) ablation has been estimated at up to 10%. Over the last decade, colchicine has been increasingly used for prevention of pericarditis after AF ablation. However, there are no established guidelines for preventative colchicine, no accepted dosage protocol, and no data regarding compliance with colchicine use. To estimate the usage of and compliance with colchicine for prevention of post-AF ablation pericarditis in real-world electrophysiology practices. The REAL-AF registry is the largest physician-driven registry of AF ablation in the United States, with a combined annual AF ablation volume of around 10,000 procedures by 80 operators. We circulated a Colchicine Use survey among all REAL-AF registry participants to estimate preventive colchicine usage as well as the dosage protocol and patient compliance. Sixty one (75%) registry participants responded to the survey. The majority (91.8%) used high power short duration (HPSD) ablation with 40-50 Watts in the left atrium (LA). Only 12 (21%) respondents had a pre-specified protocol for pericarditis prevention for all patients while another 12 (21%) operators used a selective protocol dependent upon extent of LA ablation beyond pulmonary veins. Colchicine was part of the preventive protocol for only 14 (24.1%) operators while another 10 (16.7%) used it selectively. Colchicine dosage varied between 0.3 mg BID (30.8%), 0.6 mg daily (38.4%) and 0.6 mg BID (38.4%), with duration of prescription varying widely from 1-4 weeks (Figure 1). As many as 44% of operators estimated that at least a third of their patients were unable to comply with complete colchicine protocol (Figure 1). Despite a general aura of regular use for prevention of post-AF ablation pericarditis, colchicine is actually used for this purpose by less than a third of high-volume operators in a real-world registry, with extreme variation in colchicine dosage protocol and a relatively high prevalence of patient non-compliance. The utility of preventive colchicine needs to be studied in a systematic manner to establish a universal usage recommendation.