Higher odds of AFib episode in people with paroxysmal disease

Tying one on every day was tied to a higher risk for discrete atrial fibrillation (AFib), according to a study of acute alcohol consumption in people with paroxysmal AFib.

Among 100 participants, 56 had at least one AFib episode, and the latter was linked with two-fold higher odds with one alcoholic drink (odds ratio 2.02, 95% CI 1.38-3.17), according to Gregory M. Marcus, MD, MAS, of the University of California San Francisco, and co-authors. Those odds up went up when at least two drinks were downed (OR 3.58. 95% CI 1.63 to 7.89) in the preceding 4 hours, they reported in the Annals of Internal Medicine.

“The relationship seemed to be fairly linear—the more alcohol consumed, the higher the risk for an acute AFib event—without clear evidence of a threshold effect,” the authors wrote. “These relationships remained consistent when we examined the preceding 6 and 8 hours.”

However, study limitations included the fact that only people with paroxysmal AFib made up the population, so the risk for a discrete AFib event among the general population consuming similar amounts of alcohol could not be directly extrapolated from the data. Also, alcohol use could be one of many factors that induce an AFib event, and the study did not look at those factors.

Marcus and co-authors first presented the results at the 2021 American College of Cardiology (ACC) virtual meeting. “Alcohol is the most commonly consumed drug in the world, and there is still a lot we don’t understand about what it does to our bodies and, in particular, our hearts,” Marcus stated in an ACC press release. “Patients have been telling us that alcohol is a trigger for AFib for a long time, but it’s been hard, if not impossible, to study because there is a critical temporal relationship that requires a real-time assessment of alcohol intake and heart rhythm.”

A January 2021 study in the European Heart Journal also reported that people who regularly drink a modest amount of alcohol were at an increased risk of AFib. Those investigators from Germany looked at nearly 108,000 people and found that low doses of alcohol were tied to a reduced risk of heart failure versus those who abstained from alcohol, but a similar J-shape reduction in risk was not seen for AFib.

“These findings are important as the regular consumption of alcohol, the ’one glass of wine a day’ to protect the heart, as is often recommended for instance in the lay press, should probably no longer be suggested without balancing risks and possible benefits for all heart and blood vessel diseases, including atrial fibrillation,” advised Renate Schnabel, PhD, of the University Heart and Vascular Center in Hamburg-Eppendorf, in a European Society of Cardiology press release.

And a 2020 study out of Australia reported in the New England Journal of Medicine (NEJM) that patients with AFib who laid off the booze saw a significant drop in the number of AFib episodes they experienced.

However, authors of multiple separate accompanying editorials pointed out some issues with these studies. For the German research, “the study did not report the absolute risks of [AFib] associated with low levels of alcohol consumption. This important issue has to be taken into account when also considering the potentially beneficial associations of modest alcohol intake with other cardiovascular outcomes,” noted David Conen, MD, MPH, and Jorge Wong, MD, both of McMaster University in Hamilton, Ontario, Canada.

For the Australian study on the impact of alcohol abstinence on AFib, Anne Gillis, MD of the University of Calgary in Alberta, Canada, stressed in an NEJM editorial that “the sobering reality is that for many persons with atrial fibrillation, total abstinence from alcohol may be a difficult goal to achieve.”

As for the current research, editorialists Mariann R. Piano, PhD, of Vanderbilt University School of Nursing in Nashville, and Chueh-Lung Hwang, PhD, of the University of Illinois at Chicago, highlighted several additional limitations:

  • Actual blood alcohol concentrations were not reported.
  • The definition of “any transdermal” was unclear.
  • Was the alcohol sensor reliable enough to detect “low levels of alcohol use (1-3 drinks)”?
  • There were only 22 women in the study.

Still, they acknowledged that “[p]erhaps it is time to make patients aware, especially those with a history of paroxysmal [AFib], that alcohol consumption should be carefully monitored because it can be a risk factor for recurrent [AFib].”

The current study participants (mean age 64; 79% male; 85% White) had documented paroxysmal AFib and consumed at least one alcoholic drink/month, but could not have a documented substance use disorder. They agreed to be fitted with a continuous ECG monitor and an ankle-worn transdermal alcohol sensor for 4 weeks.

The authors explained that participants “were instructed to press a patient activator button on the ECG monitor only when and every time they had a standard alcoholic drink, which they were told would equal a standard glass of wine (the amount expected to receive when poured a glass of wine at a restaurant), a 12-ounce bottle or can of beer, or a shot of spirits; pressing the button then time-stamped every standard drink consumed.”

In a related note, another study in the European Heart Journal by Schanbel’s group showed that there were no large differences in the associations by type of alcoholic beverages and AFib risk, although the authors of a letter to the editor pointed out that “it appears that for any daily number of drinks, the wine drinkers were at a lower atrial fibrillation… risk than the spirits drinker.”

Participants also underwent fingerstick blood tests for the presence of phosphatidylethanol (PEth) to corroborate drinking events as PEth can be detected after a single drink, according to Marcus’ group. The PEth test was given at follow-up at 2 and 4 weeks into the study, and 71% showed positive results, which correlated with both real-time recorded drinking events and transdermal sensor-detected events.

Real-time recordings of alcohol consumption showed a median of 19 drinks on a median 12 different days, with participants imbibing a median of one festive libation/day throughout the study period, they reported.

The authors found that AFib occurred on a median of five different days to 56% of the participants, 83.5% of whom were men. The median number of real-time recorded drinks was similar between those who had an AFib episode (n=20 drinks) and those who did not (n=18). However, transdermal sensor-detected events were higher in the AFib group at 38 versus 21 in the non-AFib group.

Marcus and co-authors found that AFib episodes also were linked with increased blood alcohol concentration measured using the transdermal alcohol sensor during the previous 12 hours, such that the odds of AFib were 38% greater per 0.1% increase in peak blood alcohol concentration in the past 12 hours (OR 1.38, 95% CI 1.04-1.83, P=0.024).

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

What these results will mean for the commonly held belief that the polyphenols in red wine may actually be cardioprotective remains to be seen. One thing that is more certain is that alcohol consumption shot up during the pandemic: A 2020 survey-based study had participants reporting consuming 26.8 alcohol drinks on 12.2 of the past 30 days, while one-third reported binge drinking and 7.0% reported extreme binge drinking to manage “Covid-19 related stress,” while data from a July 2021 study showed that total weighted sales of alcohol in the U.S. from April to June increased from $7.10 billion in 2019 to $9.55 billion in 2020 for a >34% relative change.

  1. Alcohol consumption substantially increased the risk for an atrial fibrillation (AFib) episode within a few hours in people with paroxysmal AFib.

  2. The risk for a discrete AFib event among the general population consuming similar amounts of alcohol could not be directly extrapolated from the study, which also had a very low number of women.

Shalmali Pal, Contributing Writer, BreakingMED™

The study was funded by the National Institute on Alcohol Abuse and Alcoholism.

Marcus reported relationships with, and/or support from, Baylis, InCarda, and Johnson & Johnson (J&J). Co-authors reported relationship with, and/or support from, VivaLNK, Samsung, Huba Pharmaceuticals, J&J, Amgen, Merck, the NIH, and the CDC.

Piano and Hwang reported no relationships relevant to the contents of this paper to disclose.

Cat ID: 2

Topic ID: 74,2,730,2,913,130,38,192,925