1Introduction of colchicineDing Chunhua, Cardiac Arrhythmia Treatment Center, Guangdong Hospital of Traditional Chinese Medicine
Colchicine, an alkaloid, is also known as colchicine because it was originally extracted from the lily plant Colchicine. As early as the 18th century, colchicine has been used for the treatment of acute gout, as it can inhibit granulocyte infiltration and lactic acid production, acting as an anti-inflammatory and analgesic agent. It has specific effects on acute gouty arthritis, and the symptoms of redness, swelling, pain and heat in the joints can disappear within a few hours after using the drug. It is not effective against general pain, inflammation and chronic gout, and does not affect the excretion of uric acid or its concentration in the blood.
(↑Colchicine chemical structure formula)
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Colchicine for the prevention of post-ablation atrial fibrillation
A randomized controlled study of 161 patients after pulmonary vein isolation for paroxysmal atrial fibrillation by Deftereos S in 2012 in Greece found that colchicine was an effective and safe agent to prevent early recurrence of atrial fibrillation after PVI (in the absence of antiarrhythmic drugs). Of the 81 patients in the study who were given 0.5 mg of oral colchicine twice daily, only 16% had a recurrence of AF at 3-month follow-up, compared to 33.5% in the placebo group. Patients taking colchicine also showed a significant reduction in inflammatory markers such as CRP and IL-6.
(↑ Colchicine reduces the recurrence rate of atrial fibrillation 3 months after atrial fibrillation ablation.)
In 2014, the authors extended the follow-up period and expanded the sample size of the above study and found that it was effective in reducing the recurrence rate of AF after a single RF ablation, while improving the quality of life. After 15 months of follow-up, the recurrence rate in the colchicine group was 31.1% (32/103 cases), compared to 49.5% (51/103 cases) in the placebo group, and the colchicine group reduced the relative risk ratio by 37%. Also the quality of life scores were better in the colchicine group. This suggests that colchicine is effective in the medium and long-term prevention of recurrence of RF ablation of atrial fibrillation.
A study published in Circulation in 2013 by Yasuyuki Egami from Japan also found that colchicine, 0.5 mg orally once daily for 2 weeks, suppressed the inflammatory response in patients with atrial fibrillation, thereby reducing the recurrence rate of atrial fibrillation, with a 31% vs. 53% recurrence rate in the colchicine vs. placebo group (11/36 vs. 27/51 cases). (11/36 vs. 27/51 cases).
The mechanism by which colchicine prevents recurrence after AF surgery is mainly related to its inflammatory inhibitory effect. After radiofrequency ablation of atrial fibrillation, local damage is produced in the heart, which stimulates an inflammatory response, so the inflammation-inhibiting effect of colchicine becomes an advantage in preventing recurrence after atrial fibrillation.
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Precautions for colchicine application
Colchicine, as an inhibitor of mitosis, is effective but also has certain side effects, the most common of which include
It can cause leukopenia, thrombocytopenia and anemia, and the degree of reaction is related to individual differences.
Gastrointestinal reactions: Most common, manifested as lack of appetite, nausea, vomiting, bloating, diarrhea, constipation, and in severe cases, intestinal paralysis.
It can inhibit respiratory centers, increase sensitivity to central depressant drugs, enhance the response to sympathomimetic drugs, and cause vasoconstriction. It can also cause hypertension through excitation of the vasomotor center.
Others: soreness in the extremities, phlebitis, and leakage outside the blood vessels can cause local tissue necrosis.
However, in general, small oral doses are safe, especially in preventing recurrence of atrial fibrillation after radiofrequency ablation. 0.5 mg orally twice daily under medical supervision is safe and effective, as has been confirmed in the above clinical studies.
In addition, small doses of colchicine have been shown to be useful in preventing myocardial infarction and improving the inflammatory status of patients with heart failure, especially in patients with acute attacks of gout.
In conclusion, after adequate evaluation by clinicians, low-dose oral colchicine after radiofrequency ablation of atrial fibrillation is safe and also of good benefit to patients, and deserves further in-depth exploration.
References.
1.Deftereos S, Giannopoulos G, Kossyvakis C, Efremidis M,Panagopoulou V, Kaoukis A, Raisakis K, Bouras G, Angelidis C, Theodorakis A,Driva M, Doudoumis K, Pyrgakis V, Stefanadis C. Colchicine for prevention ofearly atrial fibrillation recurrence after pulmonary vein isolation: arandomized controlled study. J Am Coll Cardiol. 2012 Oct 30;60(18):1790-6.
2. Deftereos S, Giannopoulos G, Efremidis M, Kossyvakis C,Katsivas A, Panagopoulou V, Papadimitriou C, Karageorgiou S, Doudoumis K,Raisakis K, Kaoukis A, Alexopoulos D, Manolis AS, Stefanadis C, Cleman MW.Colchicine for prevention of atrial fibrillation recurrence after pulmonaryvein isolation: mid-term efficacy and effect on quality of life. Heart Rhythm.2014 Apr;11(4):620-83.Egami Y, Nishino M, Tanouchi J. Correlation between left atrial epicardial adipose tissue volume and acute effects of colchicine treatment after atrial fibrillation ablation (Abstract 12945). Circulation. 2013;128:A12945.
4. National Pharmacopoeia Committee. Pharmacopoeia of the People’s Republic of China: 2010 edition: the first supplement [M]. Beijing: China Medical Science and Technology Press, 2010.
The Cardiac Arrhythmia Center of Guangdong Provincial Hospital is located in the beautiful environment of Guangzhou University City, founded by the director of the University of California Heart Center, Ding Chunhua, as the leader of the discipline, specializing in the diagnosis and treatment of cardiovascular diseases, focusing on the diagnosis and treatment of arrhythmia-related diseases and research work. The department is equipped with complete arrhythmia diagnosis and treatment tools, such as upright tilt test, esophageal electrophysiological examination and intracardiac electrophysiological examination, etc. The cardiac electrophysiological catheterization laboratory has introduced the most advanced Ensite velocity three-dimensional calibration system, CardioLab multi-conductor electrophysiological system, Siemens large C-arm angiography X-ray machine and other equipment to carry out radiofrequency ablation of arrhythmias, permanent artificial pacemakers and automatic in vivo de-escalation. The university is equipped with the world’s leading optical marker system, CardioLab multi-conductor physiology system, Siemens large C-arm angiography X-ray machine and other equipment to perform radiofrequency ablation of cardiac arrhythmias, permanent artificial pacemaker and automatic defibrillator implantation. We have a cardiac electrophysiology research laboratory equipped with the international leading optical marker system and diaphragm clamp electrophysiology system, and are cooperating with the University of California Heart Center in clinical research, basic research and disease diagnosis and treatment, etc. We are implementing the integrated development of medicine, education, research and development, and building a joint diagnosis and research platform with international academic level and optimal medical technology.
We fully utilize the technical characteristics and unique advantages of traditional Chinese medicine and Chinese herbal medicine in our hospital, with Professor Deng Tietao, who is known as the “Titan of Chinese medicine”, Academician Chen Keji of the Chinese Academy of Sciences, Professor Huang Chunlin and Professor Wu Huanlin, who are famous Chinese medicine practitioners, as academic leaders, with “Chinese and Western medicine teachers specializing in their own specialties With the characteristic of “joint diagnosis and treatment of patients by Chinese and Western medicine”, we provide patients with individualized and optimized treatment plans of Chinese and Western medicine.
The Cardiac Arrhythmia Center has 21 beds, one senior title, one doctoral supervisor, three attending physicians, two post-doctors, and three masters. It also has a cardiac electrophysiology research laboratory with full-time senior researchers, and carries out research on arrhythmia diseases and drug development by using international leading research equipment such as optical marker test and diaphragm clamp.
Interventional procedures are carried out.
1. catheterized radiofrequency ablation treatment: pre-excitation syndrome, paroxysmal supraventricular tachycardia (supraventricular tachycardia)
2. Three-dimensional marker and catheter radiofrequency ablation for atrial premature beats (A.M.), atrial tachycardia (A.T.), atrial flutter (A.F.), atrial fibrillation (A.F.), ventricular premature beats (V.M.), ventricular tachycardia (V.T.)
3. Pacemaker for slow arrhythmias, syncope
4. Ventricular resynchronization for heart failure
5. implantable cardioverter-defibrillator (ICD) for malignant arrhythmias
6. Syncope or dizziness/fainting, family, congenital or complex ECG for intracardiac electrophysiological examination
Chinese medicine special treatment: Based on the guidance and experimental research of famous veteran Chinese medicine doctors, we use Chinese medicine prescriptions, ear acupuncture, abdominal acupuncture, body acupuncture, acupuncture point application, foot massage, etc. combined with medicinal food and conditioning to treat cardiac arrhythmias comprehensively.
Directions by car: Take University City Line 4, Island Line 383, 384, 385 and 387 to reach the hospital. Take No. 86, 310, University City Line 1-3, Island Line 381A, 385 to Central West Station and walk about 10 minutes to the hospital. There is a free transportation bus to and from the hospital at Exit D of University City North Station of Metro Line 4 (7:45 am-5:30 pm); there are 383 and 387 at Exit B to the hospital.
Contact: Department phone: 020-39318591. micro signal: xinglin heart rhythm
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