Colchicine in atrial fibrillation: mechanisms, highlights, and current evidence

Currently, the global incidence of atrial fibrillation (AF) is rising, and its associated complications, such as stroke, heart failure, and thromboembolism, severely impair patients’ quality of life and increase mortality and healthcare burdens. With the in-depth investigation into the mechanisms underlying the initiation and maintenance of AF, apart from classic mechanisms such as electrical remodeling, structural remodeling and autonomic nervous system dysfunction, the role of inflammatory response in the pathogenesis of AF has attracted increasing attention. Colchicine has been used as an anti-inflammatory agent for the treatment of gout and familial Mediterranean fever for many years, and it has shown favorable safety and tolerability. With continuous research, it has also demonstrated great potential in cardiovascular diseases and has been applied to the treatment and prevention of pericarditis and coronary heart disease. This article aims to summarize the mechanisms underlying colchicine’s prevention of AF, discuss dosage applications for AF, outline the accumulated evidence for colchicine in preventing AF across different surgical types and disease categories, and provide an outlook on future research directions.