Can Colchicine Reduce Post-TAVR Conduction Disturbances?

Courtesy of Dr. Juan Manuel Pérez.

Partly caused by perioperative inflammation, conduction disturbances often follow TAVR. Colchicine, known for its anti-inflammatory beneficial effect on other cardiovascular conditions, had not yet been assessed in this context. 

This retrospective multicenter trial, based on US healthcare TriNetX data, looked at the use of colchicine (unspecified dose) within 3 months prior TAVR and the incidence of conduction disorders, vs. patients never exposed to it. 

Of a total 52,860 patients undergoing TAVR between 2013 and 2024, 702 received colchicine prior procedure. Mean patient age was 77.5 ± 8.7 and 62% were men. The primary end point, assessed at 1 and 6 months, was new or worse left bundle branch block (LBBB) and atrioventricular block (AV block), including first, second and third degree, and the combination of conduction disorders (CD) (1°, 2° and 3° AV block and LBBB). Secondary end points included high degree AV/LBBB, need for permanent pacemaker implantation (PPM), or temporary pacing (TP), arrhythmias, de novo atrial fibrillation, prosthesis-related mechanical complications, cardiac-related hemodynamic instability and mortality. 

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At one month, colchicine was associated with lower risk of AV/LBBB (34.3% vs. 39.6%; p=0,041) and any CD (41.5% vs. 46.7%; p=0.047). However, at 6 months, there were no significant differences in AV/LBBB (37.6% vs. 42.5%; p=0.064) or CD (45.0% vs. 49.3%; p=0.109). Neither were there differences in need for PPM implantation, TP, high grade AV/LBBB, arrhythmias, atrial fibrillation, prosthesis complications, cardiac driven hemodynamic instability or mortality. 

Sensitivity analysis showed that, when excluding patients with prior conduction disorders, colchicine reduced one month-risk of de novo AV/LBBB (24.5% vs. 30.7%; p=0.049), CD (30.2% vs. 37.4%; p=0.031) and high grade AV/LBBB (20.0% vs. 26.0%; p=0.045). This benefit was more evident after 2020, which coincides with shallower implantation techniques, highlighting the inflammatory component. However, these differences were not maintained after 6 months. 

Conclusion 

Colchicine, 3 months prior TAVR, was associated with lower incidence of AV/LBBB and CD during the first month after procedure, especially in patients with no prior conduction disorders. However, there were no differences at 6 months or other major clinical outcomes. Prospective randomized studies are required to confirm these findings and define the role of colchicine in the prevention of TAVR conduction disorders.

Original Title: Preoperative Colchicine and Conduction Disturbances After Transcatheter Aortic Valve Implantation: A US Retrospective Cohort Analysis.

Reference: Kerollos Abdelsayed et al. Journal of the American Heart Association, 2025;14:e043791. DOI:10.1161/JAHA.125.043791.