Evaluating the risk of atrial fibrillation in patients with chronic recurrent pericarditis prescribed colchicine: Observations using TriNetX global federated research network

BACKGROUND: Chronic pericarditis is associated with significant cardiovascular morbidity, including atrial fibrillation (AF), heart failure (HF), and stroke. Colchicine is widely used in pericarditis management for its anti-inflammatory effects, but its impact on arrhythmias and other cardiovascular outcomes remains uncertain. METHODS: We conducted a retrospective observational cohort study using the TriNetX global federated research network to assess the association between colchicine use and cardiovascular outcomes in in-patients with chronic pericarditis. Patients diagnosed with chronic adhesive and constrictive pericarditis with or without colchicine use between 2010 and 2024 were included. Propensity score matching (PSM) (1:1) was used to balance baseline characteristics. The primary outcome was 1-year incidence of AF. Secondary outcomes included all-cause mortality, ischemic stroke, acute myocardial infarction (AMI), acute HF, cardiac arrest, ventricular arrhythmias, and a composite cardiovascular outcome. RESULTS: Of 8,120 patients hospitalized with chronic pericarditis, 1,064 received colchicine. 1,061 patients were matched in each group after PSM. The 1-year incidence of AF was similar between colchicine users and non-users (HR: 0.90, 95% CI: 0.76–1.06) after PSM. Colchicine use was associated with significantly lower risk of all-cause mortality (HR: 0.67, 95% CI: 0.54–0.84) and ischemic stroke (HR: 0.45, 95% CI: 0.29–0.67) after PSM. No significant differences were observed for AMI, cardiac arrest, HF, or ventricular arrhythmias. CONCLUSION: In this real-world cohort of patients with chronic pericarditis, colchicine did not increase the risk of AF. Colchicine was linked to significantly lower risks of all-cause mortality and ischemic stroke in hospitalized chronic pericarditis patients, suggesting potential systemic cardiovascular benefits.