Page last updated: August 20, 2013
Alcohol may trigger atrial fibrillation episodes

Results of a study suggest that patients with paroxysmal atrial fibrillation (PAF) should avoid consuming alcohol to reduce the risk of AF episodes, but the exact link between alcohol and arrhythmias is still poorly understood.
Dr Gregory Marcus and medical student Mala Mandyman (University of California, San Francisco) are the lead authors of a study, to be published in the August issue of the American Journal of Cardiology. The study compared the self-reported frequency of PAF episodes in patients with previously documented PAF with the frequency of episodes of patients with other types of supraventricular tachycardia (SVT).
At a single center, 223 patients with a documented arrhythmia (133 with PAF and 90 with SVT) completed a survey detailing their alcohol-consumption pattern and arrhythmia episodes. Episodes were considered triggered by vagal activation if the subject’s episodes usually began while the patient was resting or eating or if the symptoms terminated with exercise. If the episode was triggered after the patient was exercising, stressed, or consuming caffeine, the episode was considered triggered by sympathetic activation.
After multivariable adjustment, the patients with PAF had a 4.42 greater odds of reporting alcohol consumption (p=0.014) and a 2.02 greater odds (95% CI 1.02-4.00) of reporting vagal activity (p=0.044) as the arrhythmia trigger compared with patients with SVT. Younger age (odds ratio 0.68, p=0.022) and a family history of AF (OR 5.73, p=0.028) each were independently associated with vagal activation of episodes. Patients with PAF and alcohol triggers were more likely to report vagal triggers of arrhythmias (OR 10.32, p=0.045).
In patients with PAF, beer was the type of alcohol most commonly cited as a trigger (odds ratio 4.49, p=0.011), although the authors note that the questionnaire only asked what type of alcohol the subject drank the most, rather than what they were drinking before each episode. This association may be due to beer drinkers generally drinking more alcohol overall compared with those who prefer wine or spirits, but this association persisted after adjustment for average consumption and bingeing.
Marcus comments that “It does appear that certain patients are more or less prone to alcohol triggering their symptoms. I don’t think we know—there are conflicting data from large epidemiological studies—if alcohol actually causes atrial fibrillation.  So there are insufficient data to give a strong recommendation, [but] certainly in people in whom alcohol has triggered atrial fibrillation, I recommend abstinence. With everyone else moderation”.
Mandyam M, Vedantham V, Scheinman MM, et al. Alcohol and vagal tone as triggers for paroxysmal atrial fibrillation. Am J Cardiol 2012; DOI:10.1016/j.amjcard.2012.03.033.

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