Associations Between Alcohol Intake and Genetic Predisposition With Atrial Fibrillation Risk in a National Biobank

Alcohol Consumption and Atrial Arrhythmia Recurrence After Atrial Fibrillation Ablation: A Systematic Review and Meta-analysis

BACKGROUND

Although alcohol consumption is associated with an increased risk of atrial fibrillation (AF), it is unclear whether alcohol is associated with AF recurrences after catheter ablation for AF. We aimed to systematically review the medical literature to assess the impact of alcohol consumption on the recurrence of AF after AF ablation.

METHODS

A structured electronic database search of the scientific literature (Medline, Embase, and Central from inceptions to December 2021) was performed for studies reporting rates of AF recurrence after catheter ablation stratified by patients' level of alcohol consumption according to study-specific definitions. Unadjusted study-specific odds ratios (ORs) were meta-analysed with the use of random-effects models. Risk of bias was evaluated by means of the ROBINS-I tool.

RESULTS

We identified 9 observational studies which included 5436 patients who underwent catheter ablation for AF. Compared with patients consuming little or no alcohol, patients consuming moderate to high amounts of alcohol had a greater risk of AF recurrence (summary OR 1.45, 95% confidence interval [CI] 1.06-1.99; P = 0.02; I² = 79%). Results remained robust when we excluded studies with < 100 participants (OR 1.40, 95% CI 1.03-1.9) or abstract-only publications (OR 1.84, 95% CI 1.21-2.8). All included studies were found to be at serious risk of bias, primarily due to confounding.

CONCLUSIONS

Increased alcohol consumption is associated with an increased risk of AF recurrence after catheter ablation for AF. Reduction of alcohol consumption may be beneficial in this context.

A narrative review of chronic alcohol-induced atrial fibrillation

Alcohol use disorder (AUD) is highly prevalent and can lead to many cardiovascular complications, including arrhythmias. Chronic alcohol use has a dose-dependent relationship with incidence of atrial fibrillation (AF), where higher alcohol intake (>3 drinks a day) is associated with higher risk of AF. Meanwhile, low levels of chronic alcohol intake (<1 drink a day) is not associated with increased risk of AF. Mechanistically, chronic alcohol intake alters the structural, functional and electrical integrity of the atria, predisposing to AF. Increased screening can help identify AUD patients early on and provide the opportunity to educate on chronic alcohol use related risks, such as AF. The ideal treatment to reduce risk of incident or recurrent AF in AUD populations is abstinence.

The proarrhythmic conundrum of alcohol intake

The arrhythmogenic potential of alcohol consumption that leads to cardiac arrhythmia development includes the induction of both atrial and ventricular arrhythmias, with atrial fibrillation (AF) being the commonest alcohol-related arrhythmia, even with low/moderate alcohol consumption. Arrhythmias occur both with acute and chronic alcohol use. The "Holiday Heart Syndrome" relates to the occurrence of AF, most commonly following weekend or public holiday binge drinking; however, other arrhythmias may also occur, including other supraventricular arrhythmias, and occasionally even frequent ventricular premature beats and a rare occurrence of ventricular tachycardia. Arrhythmias in individuals with alcohol use disorder, in addition to AF, may comprise ventricular arrhythmias (VAs) that may be potentially fatal leading to cardiac arrest. The effects of alcohol on triggering VAs appear to be dose-dependent, observed more commonly in heavy drinkers, both in healthy individuals and patients with underlying structural heart disease, including ischemic heart disease and alcoholic cardiomyopathy. Men appear to be affected at higher dosages of alcohol, while women can suffer from arrhythmias at lower dosages. On the other hand, low to moderate consumption of alcohol may confer some protection from serious VAs and cardiac arrest (J- or U-curve phenomenon); however, abstinence is the optimal strategy. These issues as they relate to alcohol-induced proarrhythmia are herein reviewed, with the large studies and meta-analyses tabulated and the arrhythmogenic mechanisms pictorially illustrated.