Colchicine for Prevention of Postoperative Atrial Fibrillation After Coronary Artery Bypass Grafting: Mechanisms, Evidence, and Clinical Implications

Cardiovascular disease represents the foremost cause of mortality globally. Annually, there are approximately 720,000 new cases of myocardial infarction and 335,000 recurrent events. Coronary artery bypass grafting (CABG) continues to be a primary intervention for multivessel coronary artery disease, employing venous or arterial conduits to circumvent obstructed coronary vessels. In the United States, approximately 200,000 CABG procedures are conducted each year. Compared with percutaneous coronary intervention (PCI), CABG is favoured in patients with advanced atherosclerosis, diabetes, and complex coronary anatomy. Despite advancements in surgical techniques and perioperative care, CABG continues to be associated with significant complications, including infection, stroke, renal failure, pneumonia, pulmonary embolism, pleural effusion, arrhythmias, prolonged ventilatory support, myocardial infarction, post-pericardiotomy syndrome, and delirium. The occurrence of these complications is contingent upon pre-existing risk factors as well as intraoperative and postoperative variables. One significant postoperative complication is atrial fibrillation, which affects 16–50% of patients and typically manifests 2–4 days following surgery. Colchicine, an anti-inflammatory agent traditionally employed in the treatment of gout, familial Mediterranean fever, and pericarditis, has emerged as a potential therapeutic option for mitigating inflammation-associated complications, such as POAF. This review investigates the role of colchicine in the prevention of POAF following CABG, analysing proposed mechanisms, relevant clinical trials, and potential clinical implications.