Author + information
- Spyridon Deftereos, MD and
- Georgios Giannopoulos, MD⁎ ()
- ↵⁎Cardiology Department, Athens General Hospital “G. Gennimatas”, 154 Mesogeion Avenue, 11527 Athens, Greece
We thank Dr. Filgueiras-Rama and colleagues for their interest in our work. We agree that 3 months of follow-up are not enough to demonstrate the clinical efficacy of an intervention against atrial fibrillation (AF) recurrence. This is exactly why the aim of our paper, as clearly stated in the introduction of our published paper (1), was not to demonstrate long-term clinical efficacy. The goal was rather to prove the principle that an anti-inflammatory treatment, which can be administered safely for a relatively prolonged period of time (and only colchicine has these characteristics among existing anti-inflammatory treatment options) can lead to a reduction in the rate of AF recurrence within the time limits during which inflammatory processes are perceived to play a role in post-ablation AF recurrence (i.e., a few weeks to 2 to 3 months). To study long-term clinical efficacy, we have an extended protocol underway and 1-year results will be published in due time. These results also will include quality-of-life assessment measures. We hope that this will address the authors' concerns regarding the effect of colchicine treatment on quality of life. However, it should be noted that, according to our experience, most patients are more frustrated and disappointed by a recurrence of their arrhythmia (by which they were, after all, troubled enough to consent to undergo an interventional procedure) than by mostly mild and easily manageable gastrointestinal side effects.
The claim that patients receiving more aggressive ablation protocols (including ablation of complex fractionated electrograms) would be more likely to benefit from colchicine treatment is obviously an issue to be determined by future research. However, our data do not show an interaction between the ablation of complex fractionated electrograms and the reduction of AF recurrence by colchicine. On a more general note, our findings seem to be independently corroborated by a similar smaller study from Japan, presented in the 2012 American Heart Association Scientific Sessions by Egami et al. (2), showing that a 2-week course of colchicine resulted in less AF recurrences after ablation for paroxysmal AF. As for the conjecture of Filgueiras-Rama et al. that “other substrates such as persistent AF, […] might benefit from using colchicine to prevent AF recurrences after the procedure,” it might be true, but we are not aware of any existing evidence to support it. From a pathophysiological point of view, one would actually expect anti-inflammatory treatment to be less effective in persistent or permanent AF, where structural substrate factors are known to play a prominent part in AF recurrence and perpetuation, than in paroxysmal AF, where substrate alterations are expected to be less marked.
- American College of Cardiology Foundation
- Deftereos S.,
- Giannopoulos G.,
- Kossyvakis C.,
- et al.
- ↵Egami Y, Nishino M, Tanouchi J, Yamada Y. Colchicine can reduce early recurrence of atrial fibrillation after pulmonary vein isolation. Paper presented at: American Heart Association Scientific Sessions; November 5, 2012; Los Angeles, CA.