Acute alcohol consumption may increase AFib risk

Consuming at least one glass of wine, a bottle/can of beer, or a shot of hard liquor appears to be associated with an increased risk of an atrial fibrillation (AFib) episode within 4 hours post-drink, according to the HOLIDAY* Monitors study presented at the ACC.21 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,” said lead author Dr Gregory Marcus from the University of California, San Francisco, California, US. “Based on our data, we found that alcohol can acutely influence the likelihood that an episode of AFib will occur within a few hours, and the more alcohol consumed, the higher the risk of having an event.”

This trial enrolled 100 patients with paroxysmal AFib (mean age 64 years, 80 percent male) who consumed at least one alcoholic drink in a month. Participants were given a wearable Lifewatch ACT monitor (n=27) and two consecutive Zio patches (n=73) to record their ECGs throughout the 4-week study period. Patients were also given a SCRAM** device, a transdermal alcohol sensor placed around the ankle, to detect if ≥2 drinks were consumed on one occasion, and were instructed to press the patient activator button whenever they consumed alcohol. Phosphatidylethanol testing was performed to measure alcohol consumption at in-person visits at weeks 2 and 4. [ACC.21, abstract 411-14]

Majority of the participants wore the ECG monitor for >27 days, and a median of 19 alcohol drinks were consumed over a median of 12 days.

Over the 4-week study, 56 participants had at least one AFib episode, which occurred on a median of five days.

Based on real-time self-reported drinking events, the risk of an AFib episode was increased within 4 hours after consuming one alcoholic beverage (odds ratio [OR], 2.02; p=0.002), more so when consuming ≥2 beverages (OR, 3.58; p=0.002). “[These findings are a] very clear [indication] that more is not better when it comes to alcohol. Those who drink more have a higher risk of heart attack [than those who drink less],” Marcus said.

Based on data from the SCRAM device, the authors found that every 0.1 percent increase in the inferred peak blood alcohol concentration within 12 hours was associated with an increased risk of an AFib episode (OR, 1.38; p=0.024).

The total area under the curve of alcohol exposure in the past 12 hours was also associated with an increased risk of an AFib episode (OR, 1.14 per 4.7 percent increase in alcohol exposure; p<0.001).

“[I]t is now fairly established from large epidemiologic studies that those who drink more alcohol tend to experience a higher risk of eventually developing a diagnosis of AFib [than those who drink less],” Marcus noted. [J Am Coll Cardiol 2011;57:427-436]

“[Although] we were not able to identify any threshold effects, such as the particular number of drinks that were required and particular alcohol concentration, … [this present study still showed] evidence that even one [alcohol] drink may heighten [AFib] risk,” said Marcus.

“In conclusion, alcohol consumption appears to heighten the risk that a discrete AFib event will occur, … [with a] delayed effect of several hours,” he said. “These data suggest that the probability a particular AFib event will occur is not simply due to random chance, but rather a common behaviour, alcohol consumption, is a modifiable exposure that may empower patients to influence the individual risk of an AFib event.”

“These findings may also suggest that understanding other acute triggers of AFib may be a fruitful field of investigation,” he added.

*HOLIDAY: HOw ALcohol InDuces Atrial TachYarrhythmias

**SCRAM: Secure Continuous Remote Alcohol Monitor