Alcohol consumption raises odds of AF episode soon after in paroxysmal AF
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In patients with paroxysmal AF, consumption of alcohol raises risk for an AF event shortly thereafter, according to data presented at the American College of Cardiology Scientific Session.
Researchers enrolled 100 patients aged 21 or older (79% men) with paroxysmal AF who consumed at least one alcoholic drink per month.
For the study, which lasted 1 month, participants were outfitted with an ECG ankle monitor (Lifewatch, Lifewatch or Zio patch, iRhythm) and wore it for a median of 27 days (interquartile range [IQR], 15-28), with 90% wearing it more than 21 days. Participants also wore a transdermal alcohol sensor.
Participants were required to press a button that was time-stamped whenever they consumed one drink of alcohol. At in-person visits at 2 and 4 weeks, participants received a blood test to confirm alcohol consumption.
“A lot of those real-time self-reported drinking events was associated with about a twofold greater risk of an AF event in the next four hours. If they hit the button two times or more, that was associated with a 3.5-fold greater risk of an AF event in the next few hours,” Gregory M. Marcus, MD, cardiologist and professor of medicine at the University of California, San Francisco, said during a press conference.
“Looking that the transdermal alcohol sensor, the level of alcohol detected by those sensors was also associated with acute AF events whether we looked at the peak alcohol concentration to the total area under the curve or the alcohol concentration,” Marcus said.
The researchers determined from real-time recordings of alcohol consumption that participants consumed a median of 19 drinks (IQR, 10-38) on a median 12 different days (IQR, 7-21).
According to the researchers, during the month of the study, 56 participants had at least one AF episode, and AF occurred on a median of 5 different days (IQR, 2.5-12.5).
Researchers observed that every 0.1% increase in the inferred peak blood alcohol concentration in the previous 12 hours was associated with 38% greater odds of an AF episode (OR = 1.38; 95% CI 1.04-1.83; P =.024).
The total area under the curve of alcohol exposure in the past 12 hours was also linked with increased risk for an AF episode (OR per 4.7% increase in alcohol exposure = 1.14; 95% CI 1.06-1.22; P <0.001), according to the researchers.
Marcus and colleagues also found that the odds of an AF event within 4 hours of drinking was elevated for any drinking event (OR = 2.26; 95% CI, 1.5-3.4; P < .001), for an event with one drink (OR = 2.02; 95% CI, 1.28-3.17; P = .002) and for an event with two or more drinks (OR = 3.58; 95% CI, 1.63-7.89; P = .002).
“These data suggest that alcohol consumption substantially heightens the risk that a discrete AF event will occur and therefore the timing and occurrence of AF episodes are not simply due to chance alone,” Marcus said at the press conference.
Perspective
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Christine Albert, MD, MPH, FHRS
This study confirms a long-time assumption that alcohol consumption can trigger AF in patients who have AF. This elegant study was quite sophisticated because researchers used a case-crossover analysis and also utilized monitoring tools to validate alcohol intake. The study also highlighted that the effect of alcohol is not immediate. Instead, there is a slight delay that may results from the parasympathetic withdrawal that occurs after intake.
For patients, the study confirms what many doctors tell their patients: minimizing alcohol intake can reduce the frequency of AF.
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Marcus GM, et al. Late Breaking Clinical Trials V. Presented at: American College of Cardiology Scientific Session; May 15-17, 2021 (virtual meeting).
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