Consuming large quantities of alcohol can prompt atrial fibrillation (AF), but can a single drink have dangerous consequences?

A recent study has yielded evidence that alcohol consumption significantly increases the chance of AF occurring within a few hours. The new study, conducted by researchers at the University of California San Francisco (UCSF), suggests that even a single glass of wine can quickly raise a drinker’s risk for AF. Authors of the study, published in Annals of Internal Medicine, note that the findings might conflict with previously held perceptions that alcohol can provide cardioprotective benefits, suggesting that avoiding or limiting alcohol consumption might reduce detrimental effects.

“Contrary to a common belief that atrial fibrillation is associated with heavy alcohol consumption, it appears that even one alcohol drink may be enough to increase the risk,” said Gregory Marcus, MD, MAS, professor of medicine and director of clinical research for the Division of Cardiology at UCSF. “Our results show that the occurrence of atrial fibrillation might be neither random nor unpredictable,” he said. “Instead, there may be identifiable and modifiable ways of preventing an acute heart arrhythmia episode.”

AF, the most common clinically seen heart arrhythmia, can lead to significant health care costs, impaired quality of life, stroke and even death. Previous research has focused largely on risk factors for developing the disease and methods of treatment rather than factors that can contribute to when and where an episode might occur.

Large studies have indicated that chronic alcohol consumption can serve as a predictor of AF, and Marcus and other researchers have demonstrated that it is associated with an increased risk of an initial diagnosis of atrial arrhythmias. The recent research focused on 100 patients with documented AF who consumed at least one alcoholic drink per month. Patients were recruited from the general cardiology and cardiac electrophysiology outpatient clinics at UCSF. Individuals with a history of alcohol or substance use disorder were excluded, as were those with certain allergies or those who were changing treatment for a particular heart condition.

Study participants wore an electrocardiogram monitor for approximately four weeks, pressing an alert button when they consumed a standard-size alcoholic drink. Additionally, participants were equipped with a continuously recording alcohol sensor. They also underwent periodic blood tests reflecting alcohol consumption over the course of the previous weeks. Participants consumed a median of one drink per day over the course of the study period.

Research indicated that an AF episode was associated with a two-fold higher incidence with one alcoholic drink and a three-fold higher incidence with two or more drinks with the preceding four hours. An increased blood alcohol concentration was also associated with the AF episodes.

Study authors acknowledged study limitations, including the possibility that participants may have forgotten to press their monitor buttons or that they minimized the number of monitor alerts due to embarrassment, although these considerations would not have affected alcohol sensor readings. In addition, the study included only individuals with established AF and not patients from the general population.

“The effects seem to be fairly linear: the more alcohol consumed, the higher the risk of an acute AF event,” Marcus said. “These observations mirror what has been reported by patients for decades, but this is the first objective, measurable evidence that a modifiable exposure may acutely influence the chance that an AF episode will occur.”

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