Introduction and methods

Acute Alcohol Consumption And Discrete Atrial Fibrillation Events

Presented at ACC.21 by Prof. Gregory Marcus, M.D (San Fransico, CA, USA)

Chronic alcohol consumption is a risk factor for the initial diagnosis of AF. In addition, patients often report that alcohol consumption appears to be a trigger for discrete AF episodes. Real-time assessment of both alcohol consumption and AF is necessary to study whether alcohol is associated with AF events.

The HOLIDAY study enrolled 100 patients (mean age 64±15 years, 79% male, 85% white) with paroxysmal AF. Participants were fitted with a wearable continuous ECG monitor and an ankle-worn transdermal ethanol sensor for 4 weeks. Participants were asked to press a button on the ECG monitor whenever they had an alcoholic drink. Finger stick blood tests that reflect the alcohol consumption in the past few weeks were additionally applied. A case-crossover analysis was performed among all participants that exhibited at least one AF episode during the study period of 4 weeks.

Main results

• One real-time self-reported alcoholic drink was associated with a 2-fold greater odds of a discrete AF episode in the next four hours (OR 2.02, 95%CI 1.28-3.17, P=0.002). Two or more real-time self-reported alcoholic drinks were associated with a 3.5-fold higher odds of an AF episode in the next four hours (OR 3.58, 95%CI 1.63-7.89, P=0.002).
• Alcohol detected by the ankle-worn transdermal sensor was also associated with the occurrence of discrete AF episodes. Every 0.1% increase in the inferred peak blood alcohol concentration in the last 12 hours was associated with a 1.38-fold greater odds of a subsequent AF episode (OR 1.38, 95%CI 1.04-1.83, P=0.024). In addition, the total area under the curve of alcohol exposure in the past 12 hours was associated with a greater odds of discrete AF episodes (OR 1.14, 95%CI 1.06-1.22, per 4.7% increase in alcohol exposure, P<0.001).

Conclusion

These data suggest that just one glass of an alcoholic drink was associated with a 2-fold greater odds and two or more alcoholic drinks were associated with a 3.5-fold greater odds of an AF episode occurring in the next four hours.

Discussion

The discussant Anne Curtis, MD (Buffalo, NY, USA) found the study very impressive. She said that these results show that there is a tight correlation between alcohol consumption and subsequent AF episodes. Alcohol consumption is modifiable. Especially patients that are trying to avoid recurring episodes should be aware that they have some control over this by limiting their alcohol intake.

-Our coverage of ACC.21 is based on the information provided during the congress –