Alcohol Abstinence in Drinkers with Atrial Fibrillation.

Abstract

BACKGROUND:

Excessive alcohol consumption is associated with incident atrial fibrillation and adverse atrial remodeling; however, the effect of abstinence from alcohol on secondary prevention of atrial fibrillation is unclear.

METHODS:

We conducted a multicenter, prospective, open-label, randomized, controlled trial at six hospitals in Australia. Adults who consumed 10 or more standard drinks (with 1 standard drink containing approximately 12 g of pure alcohol) per week and who had paroxysmal or persistent atrial fibrillation in sinus rhythm at baseline were randomly assigned in a 1:1 ratio to either abstain from alcohol or continue their usual alcohol consumption. The two primary end points were freedom from recurrence of atrial fibrillation (after a 2-week "blanking period") and total atrial fibrillation burden (proportion of time in atrial fibrillation) during 6 months of follow-up.

RESULTS:

Of 140 patients who underwent randomization (85% men; mean [±SD] age, 62±9 years), 70 were assigned to the abstinence group and 70 to the control group. Patients in the abstinence group reduced their alcohol intake from 16.8±7.7 to 2.1±3.7 standard drinks per week (a reduction of 87.5%), and patients in the control group reduced their alcohol intake from 16.4±6.9 to 13.2±6.5 drinks per week (a reduction of 19.5%). After a 2-week blanking period, atrial fibrillation recurred in 37 of 70 patients (53%) in the abstinence group and in 51 of 70 patients (73%) in the control group. The abstinence group had a longer period before recurrence of atrial fibrillation than the control group (hazard ratio, 0.55; 95% confidence interval, 0.36 to 0.84; P = 0.005). The atrial fibrillation burden over 6 months of follow-up was significantly lower in the abstinence group than in the control group (median percentage of time in atrial fibrillation, 0.5% [interquartile range, 0.0 to 3.0] vs. 1.2% [interquartile range, 0.0 to 10.3]; P = 0.01).

CONCLUSIONS:

Abstinence from alcohol reduced arrhythmia recurrences in regular drinkers with atrial fibrillation. (Funded by the Government of Victoria Operational Infrastructure Support Program and others; Australian New Zealand Clinical Trials Registry number, ACTRN12616000256471.).

• Authors: Aleksandr Voskoboinik, Jonathan M Kalman, Anurika De Silva, Thomas Nicholls, Benedict Costello, Shane Nanayakkara, Sandeep Prabhu, Dion Stub, Sonia Azzopardi, Donna Vizi, Geoffrey Wong, Chrishan Nalliah, Hariharan Sugumar, Michael Wong, Emily Kotschet, David Kaye, Andrew J Taylor, Peter M Kistler
• Journal: The New England journal of medicine (N Engl J Med) Vol. 382 Issue 1 Pg. 20-28 (01 02 2020) ISSN: 1533-4406 [Electronic] United States
• PMID: 31893513 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2020 Massachusetts Medical Society.

Topics

• Aged
• Alcohol Abstinence
• Alcohol Drinking (adverse effects)
• Atrial Fibrillation (etiology, prevention & control)
• Australia
• Female
• Follow-Up Studies
• Humans
• Male
• Middle Aged
• Prospective Studies
• Risk Factors
• Secondary Prevention