Alcohol Consumption and Discrete Atrial Fibrillation Events

Quick Takes

  • In a case-crossover analysis, an AF episode was associated with 2-fold higher odds of 1 alcoholic drink and >3-fold higher odds of ≥2 drinks in the preceding 4 hours.
  • Patients with paroxysmal AF should be advised that avoidance of alcohol may acutely reduce the risk of incident AF.

Study Questions:

Does acute alcohol consumption (i.e., drinking within a few hours before the episode) increase the risk of a discrete atrial fibrillation (AF) episode?

Methods:

Patients with history of paroxysmal AF and moderate alcohol use wore a continuous electrocardiogram monitor and a transdermal ethanol sensor for 4 weeks. Patients reported alcohol use in real time. Fingerstick blood tests for phosphatidylethanol (PEth), a metabolite of alcohol, were also analyzed.

Results:

Among 100 participants (mean age, 64 years), 56 had ≥1 episode of AF. An AF episode was associated with 2-fold higher odds of 1 alcoholic drink and >3-fold higher odds of ≥2 drinks in the preceding 4 hours. Episodes of AF were associated with higher odds of peak blood alcohol concentration and the total area under the curve of alcohol exposure inferred from the transdermal ethanol sensor. PEth testing correlated with the number of recorded drinks and with events detected by the transdermal alcohol sensor.

Conclusions:

Individual AF episodes were associated with higher odds of recent alcohol consumption, providing objective evidence that a modifiable behavior may influence the probability that a discrete AF event will occur.

Perspective:

Large epidemiologic studies have correlated greater amounts of long-term alcohol consumption and incident AF. A recent randomized trial showed that alcohol abstinence over several months can reduce AF burden. Even small amounts of alcohol have been implicated with recurrent AF, and alcohol abstinence has been linked to a reduced risk of stroke with patients with AF. The present study shows that alcohol consumption substantially increases the chance of a discrete AF episode within a few hours after drinking. The present study employed real-time alcohol use reporting, i.e., potentially before the next AF episode, reducing the confounding brought about by a recall bias. Additionally, PEth, an established marker of alcohol consumption in the past 21 days, correlated with the number of recorded drinks and with events detected by the transdermal alcohol sensor. It has been suggested that ethanol may acutely trigger AF by decreasing the atrial effective refractory period in the pulmonary veins, providing mechanistic evidence to support the findings of the present study. Patients with paroxysmal AF should be advised that avoidance of alcohol may acutely reduce the risk of incident AF.

Clinical Topics: Arrhythmias and Clinical EP, Cardiovascular Care Team, Prevention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias

Keywords: Alcohol Abstinence, Alcohol Drinking, Arrhythmias, Cardiac, Atrial Fibrillation, Blood Alcohol Content, Electrocardiography, Ethanol, Secondary Prevention, Risk, Stroke


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