In the Journals

Moderate alcohol consumption increases risk for AF

Regular moderate alcohol intake was a modifiable risk factor for atrial fibrillation that was linked to conduction slowing and lower atrial voltage, according to a study published in HeartRhythm.

“This study underscores the importance of excessive alcohol consumption as an important risk factor in AF,” Peter Kistler, MBBS, PhD, FHRS, of the Heart Centre at Alfred Hospital in Melbourne, Australia, said in the press release. “Regular moderate alcohol consumption, but not mild consumption, is an important modifiable risk factor for AF associated with lower atrial voltage and conduction slowing. These electrical and structural changes may explain the propensity to AF in regular drinkers. It is an important reminder for clinicians who are caring for patients with AF to ask about alcohol consumption and provide appropriate counseling in those who overindulge.”

Aleksandr Voskoboinik, MBBS, of the department of cardiology at Royal Melbourne Hospital in Australia, Baker Heart and Diabetes Institute in Melbourne and Heart Centre at Alfred Hospital in Melbourne, and colleagues analyzed data from 75 patients (mean age, 59 years; 69% men) with paroxysmal or persistent AF who underwent high-density left atrial mapping during AF ablation. Alcohol consumption was self-reported, and patients were categorized as mild drinkers (2-7 drinks per week; n = 25), moderate drinkers (8-21 drinks per week; n = 25) or nondrinkers (n = 25).

Compared with patients who were nondrinkers, those who moderately drank had lower mean global bipolar voltages (1.53 mV vs. 1.89 mV; P = .02). In addition, the moderate drinker group had slower conduction velocity (33.5 cm/s vs. 41.7 cm/s; P = .04) and higher proportion of complex atrial potentials (7.8% vs. 4.5%; P = .004).

Patients who mildly drank did not have differences in global voltage and conduction velocity. This patient group had a greater global complex potential compared with patients who did not drink (6.6% vs. 4.5%; P = .047). Significant increases in regional low-voltage zones, defined as less than 0.5 mV, were also seen in the septum and lateral wall in the moderate drinker group vs. the nondrinker group (P < .05).

“Although it is well-described that self-reported consumption underestimates true intake, the present study supports this ‘relatively low’ cutoff as the threshold for potential alcohol-related atrial toxicity,” Voskoboinik and colleagues wrote. “Significant electrophysiological and structural changes in atrial substrate were demonstrated in patients consuming eight to 21 drinks per week. Atrial remodeling was not significantly different for most indices in those consuming one to seven drinks per week compared to nondrinkers, which may support a potentially ‘safe’ threshold for alcohol consumption in the AF population, although this is speculative.” – by Darlene Dobkowski

Disclosures: Voskoboinik reports he is supported by National Health and Medical Research Council/National Heart Foundation postgraduate scholarships and Baker Institute Bright Sparks scholarships. Kistler reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

Regular moderate alcohol intake was a modifiable risk factor for atrial fibrillation that was linked to conduction slowing and lower atrial voltage, according to a study published in HeartRhythm.

“This study underscores the importance of excessive alcohol consumption as an important risk factor in AF,” Peter Kistler, MBBS, PhD, FHRS, of the Heart Centre at Alfred Hospital in Melbourne, Australia, said in the press release. “Regular moderate alcohol consumption, but not mild consumption, is an important modifiable risk factor for AF associated with lower atrial voltage and conduction slowing. These electrical and structural changes may explain the propensity to AF in regular drinkers. It is an important reminder for clinicians who are caring for patients with AF to ask about alcohol consumption and provide appropriate counseling in those who overindulge.”

Aleksandr Voskoboinik, MBBS, of the department of cardiology at Royal Melbourne Hospital in Australia, Baker Heart and Diabetes Institute in Melbourne and Heart Centre at Alfred Hospital in Melbourne, and colleagues analyzed data from 75 patients (mean age, 59 years; 69% men) with paroxysmal or persistent AF who underwent high-density left atrial mapping during AF ablation. Alcohol consumption was self-reported, and patients were categorized as mild drinkers (2-7 drinks per week; n = 25), moderate drinkers (8-21 drinks per week; n = 25) or nondrinkers (n = 25).

Compared with patients who were nondrinkers, those who moderately drank had lower mean global bipolar voltages (1.53 mV vs. 1.89 mV; P = .02). In addition, the moderate drinker group had slower conduction velocity (33.5 cm/s vs. 41.7 cm/s; P = .04) and higher proportion of complex atrial potentials (7.8% vs. 4.5%; P = .004).

Patients who mildly drank did not have differences in global voltage and conduction velocity. This patient group had a greater global complex potential compared with patients who did not drink (6.6% vs. 4.5%; P = .047). Significant increases in regional low-voltage zones, defined as less than 0.5 mV, were also seen in the septum and lateral wall in the moderate drinker group vs. the nondrinker group (P < .05).

“Although it is well-described that self-reported consumption underestimates true intake, the present study supports this ‘relatively low’ cutoff as the threshold for potential alcohol-related atrial toxicity,” Voskoboinik and colleagues wrote. “Significant electrophysiological and structural changes in atrial substrate were demonstrated in patients consuming eight to 21 drinks per week. Atrial remodeling was not significantly different for most indices in those consuming one to seven drinks per week compared to nondrinkers, which may support a potentially ‘safe’ threshold for alcohol consumption in the AF population, although this is speculative.” – by Darlene Dobkowski

Disclosures: Voskoboinik reports he is supported by National Health and Medical Research Council/National Heart Foundation postgraduate scholarships and Baker Institute Bright Sparks scholarships. Kistler reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.