The Impact of Alcohol Intake on Atrial Fibrillation
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INVASIVE ELECTROPHYSIOLOGY AND PACING (E. KEVIN HEIST, SECTION EDITOR)
The Impact of Alcohol Intake on Atrial Fibrillation Aleksandr Voskoboinik 1,2,3 & Gregory M. Marcus 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review To evaluate (1) the impact of acute and habitual alcohol consumption on atrial fibrillation (AF) and atrial remodeling and (2) the role of alcohol reduction and/or abstinence in the primary and secondary prevention of AF. Recent Findings Acute alcohol consumption appears to be a common AF trigger, with animal and human studies demonstrating changes in electrophysiological parameters, autonomic tone, and cellular properties expected to promote AF. Habitual consumption is associated with adverse atrial remodeling, higher risk of incident AF, and AF recurrence. Randomized data suggest that reduction in excessive alcohol consumption may reduce the risk of recurrent AF episodes and AF burden. Summary Alcohol is an increasingly recognized risk factor for both new onset AF and discrete AF episodes. Excessive consumption should be avoided for primary and secondary prevention of AF. Keywords Atrial fibrillation . Alcohol . Left atrium . Remodeling . Binge drinking . Lifestyle
Abbreviations AF Atrial fibrillation ERP Effective refractory period HR Hazard ratio LA Left atrium OR Odds ratio RR Relative risk
Introduction Atrial fibrillation (AF) is an emerging epidemic [1] and alcohol consumption ubiquitous in Western society [2]. The acute onset of arrhythmias following binge drinking was first described in the 1970s and termed “Holiday Heart Syndrome” This article is part of the Topical Collection on Invasive Electrophysiology and Pacing * Gregory M. Marcus [email protected] Aleksandr Voskoboinik [email protected] 1
Department of Cardiology, University of California, 505 Parnassus Ave, M1180B, San Francisco, CA, USA
2
Baker Heart & Diabetes Institute, Melbourne, Australia
3
Heart Centre, The Alfred Hospital, Melbourne, Australia
due to the observed higher incidence of AF episodes after weekends and public holidays. Since then, numerous studies have studied the relationship between alcohol and AF. In this review, we summarize the latest literature pertaining to the acute and chronic effects of alcohol on the atrium (Fig. 1) and the role of alcohol reduction in the primary and secondary prevention of AF.
Epidemiology Acute Relationships Numerous observational studies have established a temporal association between acute alcohol consumption and onset of an AF episode in vulnerable individuals. This was first reported by Ettinger et al. who observed a higher incidence of alcohol-related atrial arrhythmias in binge drinkers following the weekend and in December and January [3]. This was termed the “Holiday Heart Syndrome,” and while episodes usually terminated within 24 h, 26% of patients had recurrences over the next 12 months with subsequent binges [4]. In a case control of 100 individuals presenting with acute AF, alcohol intake within 2 d
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