Novel Biatrial Epicardial Colchicine-Eluting Bioresorbable Polymer Mesh for the Prevention of Postoperative Atrial Fibrillation: A Proof-of-Concept Study.

BACKGROUND

Recent clinical trials have shown that colchicine, an anti-inflammatory agent, is superior in preventing postoperative atrial fibrillation (POAF) in patients after open heart surgery. However, the systemic use of colchicine was associated with an increased incidence of gastrointestinal adverse effects, often leading patients to discontinue treatment. The objective of this study was to evaluate the effectiveness and safety of biatrial epicardial colchicine-eluting bioresorbable polymer mesh for preventing POAF in a swine sterile pericarditis model.

METHODS

Twelve domestic pigs underwent initial pericarditis surgery. During the creation of the swine sterile pericarditis model, either colchicine-eluting bioresorbable mesh (0.5-1 mg/day, 6 pigs) or only bioresorbable mesh without the drug (6 pigs) was placed on both atria. On postoperative days 1 and 2, we measured the electrophysiological properties, including pacing threshold, atrial effective refractory period, and inducibility of POAF. Blood and tissue samples were obtained to assess systemic and local inflammation.

RESULTS

The pacing threshold was significantly lower and the atrial effective refractory period was significantly longer in the colchicine-treated pericarditis pigs compared with the pericarditis control pigs. The inducibility of POAF episodes was significantly lower in the colchicine-treated pericarditis pigs (median of POAF episodes: 0, P<0.05; 3/6 pigs) compared with the pericarditis control pigs (median of POAF episodes: 1.5; 6/6 pigs). RNA sequencing analysis of local tissue revealed a decrease in differentially expressed genes associated with inflammation and cardiotoxicity in the colchicine-treated group.

CONCLUSIONS

Biatrial epicardial colchicine-eluting bioresorbable polymer mesh significantly diminished atrial inflammation, thereby reducing the inducibility of POAF in a swine sterile pericarditis model.