Colchicine Reduces Arrhythmias After Transcatheter Aortic Valve Replacement But Raises Stroke Risk

In a study published in Nature Communications, colchicine was examined to determine its efficacy in reducing conduction disturbances and arrhythmias during transcatheter aortic valve replacement (TAVR). Researchers discovered that administration of colchicine was associated with a reduced risk of new-onset arrhythmias and subclinical leaflet thrombosis within 30 days after TAVR, but the incidence of stroke associated with colchicine led to early termination.

The Co-STAR trial involved 120 patients (mean age, 80.6 years; 64% male) with symptomatic severe aortic stenosis who were undergoing TAVR at Bern University Hospital in Switzerland. The  participants were randomly assigned to two groups: one received colchicine (n=60) and the other received placebo (n=60), beginning 1 day before the  TAVR procedure. The primary end point was a composite of new-onset atrial fibrillation or atrioventricular conduction disturbances that led to implantation of a permanent pacemaker in 30 days.

On day 30, the colchicine group showed a 15% absolute risk reduction in the primary end point compared with the placebo group (10% vs 25%; P=0.031).  Subclinical leaflet thrombosis, the prespecified imaging end point, was observed in 27% of the patients in the colchicine group compared with 54% in the placebo group (P=0.007).

In spite of the clinical advantage, safety issues were observed. Five patients in the colchicine group experienced a stroke compared with none in the placebo group. The researchers did note that, by chance, more patients in the colchicine group had a history of stroke than those in the placebo group. Other safety outcomes such as bleeding, infections, and kidney damage were comparable between the groups.

Although the researchers observed major anti-inflammatory and antithrombotic effects of colchicine treatment for patients undergoing TAVR, the occurrence of stroke is a reason to be cautious. “Confirmatory trials are warranted to corroborate the effect of anti-inflammatory treatment on the incidence of arrhythmias and subclinical leaflet thrombosis after TAVR,” the authors concluded.