By Gene Emery

(Reuters Health) – For people with atrial fibrillation, abstinence from alcohol may make the heart beat better.

Eliminating most alcohol consumption dramatically cuts the number of episodes of the potentially-deadly heart rhythm disturbance among moderate and heavy drinkers, according to results of a six-month Australian study of 140 volunteers published in The New England Journal of Medicine.

While atrial fibrillation (AF), or Afib, reappeared in 73% of the people who averaged 13 drinks per week, the rate dropped to 53% among patients in the abstinence group – who weren’t supposed to drink at all but, on average, consumed two drinks weekly.

In addition, among the people trying to abstain, it took longer for their next episode of Afib to occur.

“What this study shows is the potential impact of alcohol reduction or abstinence in people with symptomatic heart rhythm problems,” co-author Dr. Peter Kistler of The Alfred Hospital in Melbourne told Reuters Health by phone. People with Afib symptoms who have 10 drinks per week should be advised to abstain or reduce their alcohol use, he said.

“Alcohol is not only a marker of increased risk of AF (as shown before, based on observational studies), but it seems to be also a real risk factor for AF, because if we ‘treat’ (in this case stop taking alcohol), we have a significant reduction in both the AF burden and the recurrence of AF,” Dr. Renato Lopes, a professor of medicine at Duke University Medical Center in Durham, North Carolina, who wasn’t involved in the study, said in an email.

Afib occurs when the upper chambers of the heart beat erratically. It is the most common heart rhythm problem and a leading cause of stroke. In some people, it comes and goes. Symptoms include weakness, shortness of breath and palpitations.

Doctors try to treat it by controlling blood pressure and other factors, but the new study “presents a compelling argument for alcohol abstinence as part of the successful management of atrial fibrillation,” writes Dr. Anne Gillis of the University of Calgary in an editorial accompanying the study. “Nevertheless, the sobering reality is that for many persons with atrial fibrillation, total abstinence from alcohol may be a difficult goal to achieve.”

In fact, the researchers were originally planning to follow patients for 12 months, but they couldn’t find enough volunteers willing to abstain from alcohol for that long.

The findings are not completely surprising. Population-based research had suggested that every drink (12 ounces of beer, 5 ounces of wine or a 1.5 ounce of distilled spirits) increases the risk of atrial fibrillation by 8%. The new randomized trial was designed to be a definitive test.

The Kistler team found it typically took 120 days for Afib to reappear in the non-drinking group versus 87 days in the group that wasn’t instructed to reduce alcohol consumption.

At the six-month mark, the hearts of the drinkers spent 1.2% of the time in Afib versus 0.5% of the time among volunteers assigned to abstinence.

Two thirds of the volunteers were taking antiarrhythmic drugs. The group allowed to continue to drink reduced their alcohol consumption a bit anyway. In the abstinence group, 61% were able to cut out alcohol completely but one quarter of the volunteers couldn’t get their weekly consumption below two drinks per week.

“Those who completely abstained had more benefit or a greater reduction in atrial fibrillation compared to those who reduced their intake but continued to drink,” Kistler noted. “If we had had complete abstinence, I think the difference would have been even greater.”

The non-drinkers also lost an average of 8 pounds more than the drinkers and saw a significant drop in blood pressure.

Doctors often advise patients that having a drink a day can be good for the heart, but that should not apply to Afib patients, Kistler said. Even in patients with heart disease, the new results “still suggest that they reduce their alcohol intake substantially.”

SOURCE: The New England Journal of Medicine, online January 1, 2020.