How much is too much? Even moderate alcohol consumption is a risk factor for atrial fibrillation

A new study published in HeartRhythm reports that regular moderate alcohol consumption, drinking an average of 14 glasses of alcohol per week, is a modifiable risk factor for atrial fibrillation


Philadelphia, January 10, 2019

Alcohol is ubiquitous in Western society, and rates of excessive use among adults remain high. Excessive alcohol consumption is an established risk factor for atrial fibrillation (AF), but what are the effects of moderate and mild consumption on AF? In a new study published in HeartRhythm, the official journal of the Heart Rhythm Society and the Cardiac Electrophysiology Society, Australian researchers showed that regular moderate alcohol consumption (an average of 14 glasses per week) results in more electrical evidence of scarring and impairments in electrical signaling compared with non-drinkers and light drinkers. Alcohol consumption is therefore an important modifiable risk factor for AF.

AF is an abnormal heart rhythm characterized by rapid and irregular beating of the atria (the two upper chambers of the heart). Observational studies suggest that even moderate regular alcohol consumption may increase the risk of AF. A meta-analysis of seven studies involving nearly 860,000 patients and approximately 12,500 individuals with AF demonstrated an eight percent increase in incident AF for each additional daily standard drink. Despite the association between regular alcohol intake and AF, however, detailed human electrophysiological studies describing the nature of alcohol-related atrial remodeling have been lacking.

The purpose of this study was to determine the impact of different degrees of alcohol consumption on atrial remodeling using high-density electroanatomic mapping. In this multi-center cross-sectional study in Australia, investigators performed detailed invasive testing on the atria of 75 patients with AF, 25 in each of three categories: lifelong non-drinkers, mild drinkers, and moderate drinkers. Patients self-reported their average alcohol consumption in standard drinks per week (one standard glass is around 12 grams of alcohol) over the preceding 12 months. Patients consuming two to seven drinks per week were considered mild drinkers, while those consuming eight to 21 drinks per week (average 14 drinks per week) were defined as moderate drinkers.

The investigators found that individuals who consumed moderate amounts of alcohol (average 14 drinks per week) had more electrical evidence of scarring and impairments in electrical signaling than non-drinkers and light drinkers.

Three dimentional images of non-drinkers, mild drinkers and moderate drinkes with voltage stimulation and propagation maps. All in all 6 images in a panel.
Representative high-density voltage (top panel) and propagation maps (bottom panel) of the posterior left atrium for non-drinkers, mild drinkers, and moderate drinkers. The moderate drinker has more scarring evident.

“This study underscores the importance of excessive alcohol consumption as an important risk factor in AF,” said lead investigator Professor Peter Kistler, MBBS, PhD, FHRS, from the Heart Centre, Alfred Hospital, Melbourne, Australia. “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 counselling in those who over-indulge.”

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Notes for editors
The article is “Moderate alcohol consumption is associated with atrial electrical and structural changes: Insights from high-density left atrial electroanatomic mapping,” by Aleksandr Voskoboinik, MBBS, Geoffrey Wong, MBBS, Geoff Lee ,MBChB, PhD, Chrishan Nalliah, MBBS, Joshua Hawson, MBBS, Sandeep Prabhu, MBBS, Hariharan Sugumar, MBBS, Liang-Han Ling, MBBS, PhD, Alex McLellan, MBBS, PhD, Joseph Morton, MBBS, PhD, Jonathan M. Kalman, MBBS, PhD, FHRS, and Peter M. Kistler, MBBS, PhD, FHRS (https://doi.org/10.1016/j.hrthm.2018.10.041). It will appear in HeartRhythm, volume 16, issue 2 (February 2019) published by Elsevier.

Full text of this article is available to credentialed journalists upon request; contact Jane Grochowski at +1 406 542 8397 or hmsmedia@elsevier.com. Journalists wishing to interview the authors should contact Professor Peter Kistler at peter.kistler@baker.edu.au.

About HeartRhythm
HeartRhythm, the official journal of the Heart Rhythm Society and the Cardiac Electrophysiology Society, is a unique journal for fundamental discovery and clinical applicability. It integrates the entire cardiac electrophysiology (EP) community from basic and clinical academic researchers, private practitioners, engineers, allied professionals, industry, and trainees, all of whom are vital and interdependent members of our EP community. www.heartrhythmjournal.com

About the Heart Rhythm Society
The Heart Rhythm Society is the international leader in science, education, and advocacy for cardiac arrhythmia professionals and patients, and the primary information resource on heart rhythm disorders. Its mission is to improve the care of patients by promoting research, education, and optimal healthcare policies and standards. The Heart Rhythm Society is the preeminent professional group representing more than 5,100 specialists in cardiac pacing and electrophysiology from more than 70 countries. www.HRSonline.org

About Elsevier
Elsevier is a global information analytics business that helps scientists and clinicians to find new answers, reshape human knowledge, and tackle the most urgent human crises. For 140 years, we have partnered with the research world to curate and verify scientific knowledge. Today, we’re committed to bringing that rigor to a new generation of platforms. Elsevier provides digital solutions and tools in the areas of strategic research management, R&D performance, clinical decision support, and professional education; including ScienceDirect, Scopus, SciVal, ClinicalKey and Sherpath. Elsevier publishes over 2,500 digitized journals, including The Lancet and Cell, 39,000 e-book titles and many iconic reference works, including Gray's Anatomy. Elsevier is part of RELX Group, a global provider of information and analytics for professionals and business customers across industries. www.elsevier.com

Media contact
Jane Grochowski, Senior Publisher
Elsevier
+1 406 542 8397
hmsmedia@elsevier.com