Colchicine as an Adjunct Therapy Postablation for Atrial Fibrillation: A Systematic Review and Meta-analysis

Atrial fibrillation (AF) recurrence following catheter ablation remains a significant clinical challenge, often attributed to postprocedural inflammation. Colchicine, an anti-inflammatory agent, has emerged as a potential therapeutic strategy to reduce recurrence. This meta-analysis evaluates the efficacy and safety of colchicine in preventing AF recurrence after ablation. A comprehensive literature search was conducted across PubMed, Embase, Scopus, and Cochrane databases through March 2025. Randomized controlled trials (RCTs) and observational studies assessing colchicine versus control in postablation AF patients were included. The primary outcome was AF recurrence; secondary outcomes included pericarditis, hospitalizations, gastrointestinal side effects, and composite clinical events. Data were pooled using a random-effects model, and subgroup and sensitivity analyses were conducted. A total of 8 studies (N = 3784 patients) were included. Colchicine significantly reduced AF recurrence [risk ratio (RR) = 0.75; 95% confidence interval (CI): 0.57-0.98; P = 0.04; I ² = 55%]. The effect was more pronounced in RCTs (RR = 0.60; 95% CI: 0.45-0.80; P = 0.0004; I ² = 0%). Colchicine was associated with an increased risk of gastrointestinal side effects (RR = 2.34; 95% CI: 1.21-4.55; P = 0.01; I ² = 75%) but had no significant effect on pericarditis (RR = 0.62; 95% CI: 0.23-1.70; P = 0.36), hospitalizations, or composite outcomes. Colchicine appears to reduce AF recurrence following catheter ablation, particularly in rigorously conducted RCTs. While gastrointestinal intolerance is a notable concern, colchicine may offer a valuable adjunctive strategy to improve ablation outcomes. Larger, well-powered trials are warranted to confirm these findings and define optimal dosing strategies.