Alcohol Abstinence Decreases Recurrence, Burden of Atrial Fibrillation

A recent multicenter trial from a team of Australian investigators is shedding more light on the impact of reducing alcohol consumption on secondary prevention of atrial fibrillation(AFib).

Results of the study, which was conducted across 6 hospitals in Australia, found AFib recurred in 20% fewer patients in the group who reduced their alcohol intake compared to those who did not abstain from consumption—the study also revealed patients in the abstinence group had a longer period before recurrence of AFib and a significantly lower AFib burden at 6 months.

To further evaluate the effect of alcohol abstinence on the secondary prevention of AFib, investigators conducted a multicenter, prospective, open-label, randomized, controlled trial that included 140 patients randomized in a 1:1 ratio to an abstinence or a control group. For inclusion in the current study, patients needed to be between the ages of 18 and 85 years old, have the presence of symptomatic paroxysmal AFib or symptomatic persistent AFib with a rhythm-control strategy, and regularly consume alcohol.

Regular alcohol consumption was defined as 10 or more standard drinks or approximately 120 g of pure alcohol per week. Exclusion criteria for the study were alcohol dependence or abuse, clinically significant noncardiac illness, coexisting psychiatric disorder or severe left ventricular systolic dysfunction, which was defined as an ejection fraction less than 35%.

All participants underwent rhythm monitoring after randomization and time to recurrence and atrial fibrillation burden were determined through cardiac rhythm management devices or the AliveCor mobile phone app. Participants in the study were asked to submit twice-daily 30-second ECG readings.

The primary endpoints of the intention-to-treat analyses were the recurrence of atrial fibrillation and atrial fibrillation burden, which investigators defined as the percentage of time a patient was in AFib during the 6-month follow-up period. Secondary endpoints of the trial included change from baseline to 6 months in weight, blood pressure, symptoms of atrial fibrillation, mood, quality of life, and hospitalizations for AFib.

A total of 697 patients were screened for participation, of which the aforementioned 140 patients met the criteria, provided informed consent, and underwent randomization. During the course of the trial, patients in the abstinence group were encouraged to abstain from all forms of alcohol for 6 months.

During the course of the trial, patients in the abstinence group 16.8±7.7 to 2.1±3.7 drinks per week, which represents an 87.5% reduction in alcohol intake (Mean difference 14.7; 95% CI: 12.7 to 16.7). Investigators also noted complete abstinence was achieved in 61% of patients in the abstinence group. In the control group, the mean alcohol intake reduced from 16.4±.6.9 to 13.2±6.5 drinks per week, which represents a 19.5% reduction (Mean difference, 3.2; 95% CI: 1.9 to 4.4).

Following a 2-week blanking period, investigators observed 53% (37 of 70) of patients in the abstinence group and 73% (51 of 70) of patients in the control group. Additionally, a longer period before recurrence of AFib (HR, 0.55; 95% CI, 0.36 to 0.84; P=0.005) and a significantly reduced burden of AFib over 6 months was noted in the abstinence group compared to the control group (median percentage of time in AFib, 0.5% (interquartile range, 0.0 to 3.0) versus 1.2% (interquartile range, 0.0 to 10.3); P=0.01).

In an editorial titled “A Sober Reality? Alcohol, Abstinence, and Atrial Fibrillation,” in the New England Journal of Medicine, Anne Gillis, MD, professor of medicine at the University of Calgary Cardiovascular Institute of Alberta, wrote the results of the current study support the idea of abstinence as part of AFib management but this may be difficult to achieve in a real-world setting.

“‘Everything in moderation’ is a common adage used in discussions of risk-factor modification with patients who have atrial fibrillation. However, the current study presents a compelling argument for alcohol abstinence as part of the successful management of atrial fibrillation,” Gillis wrote. “Nevertheless, the sobering reality is that for many persons with atrial fibrillation, total abstinence from alcohol may be a difficult goal to achieve.”

This study, titled “Alcohol Abstinence in Drinkers with Atrial Fibrillation,” was published online in the New England Journal of Medicine.