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  • Helen - @CPhysiologist

Can I drink alcohol if I have AF?

If you have a diagnosis of Atrial Fibrillation (AF) this is a question you may be asking yourself, especially now the party season is upon us.

We discussed alcohol and AF at our last group meeting, and I would like to summarise the session into the following categories:

The Good, The Bad & The Ugly

Good: If you have AF I am not necessarily going to tell you not to drink alcohol; that is not my place.

Bad: Although there is evidence to suggest that low levels of alcohol may have protective effects against coronary heart disease, this advice does not apply to AF.

Ugly: There is a well-established link between binge drinking and/or heavy alcohol consumption and AF, known as “Holiday heart Syndrome”.

However, let’s take a closer look:

Firstly, people with AF don’t want to be told they can’t drink alcohol and I believe it is an individual choice. That said, if you don’t drink alcohol already, it isn’t a good idea to start. Alcohol is a known trigger for AF, i.e., in some people it initiates a symptomatic episode.

Drinking more than a moderate amount of alcohol has several adverse effects on the body, many of which can lead to the conditions which increase the risk of AF. For example, the sugar in alcoholic drinks increase blood sugar making diabetes more likely as well as weight increase. Disturbed sleep can result from the effect alcohol has on kidney function making night-time trips to the loo more likely, together with poor quality and less restorative sleep. Sleep apnoea, diabetes and obesity are strongly associated with AF. As a stimulant, alcohol may increase anxiety levels – also linked with AF. Drinking alcohol may also affect cognition and balance, which means you’re more likely to fall over and hit your head, thereby increasing the risk of bleeding. People tend to fall into other bad habits when they drink alcohol, such as smoking and eating heavy meals, other common AF triggers.

Binge drinking, i.e., more than 3 or 4 drinks in a short time (“Holiday Heart Syndrome”), can have a direct toxic effect on the heart. Although incompletely understood and complex, in general terms there is altered structural, functional & electrical integrity of atria (the upper heart chambers), which is where AF signals arise. This is dose-dependent, which means that there is an increased risk of an adverse effect with per drink per day (8% per drink).

So, can you drink alcohol if I you AF? My top tips are:

  1. No heavy or binge drinking

  2. Does it trigger you?

  3. Consider possible interaction with medications – anticoagulants.

  4. Remember, “AF begets AF”

I hope you found this useful.

“Cheers” to an enjoyable festive season,

Helen



UK Weekly Alcohol Consumption

NHS recommendations are no more than 14 units per week.

• Light drinking= 7 drinks per week

• Moderate =7 to 21 drinks per week

• Heavy = greater than 21 drinks per week

(1 standard drink ~ 8 g or 10ml of pure alcohol)

Some recent studies:

Specific beverage study: July 2021 JACC Clinical Electrophysiology

 403,281 middle aged (52.4%) over 11 years

 Total of 21,312 incident of AF events occurred

 Past drinkers & known AF – excluded

 Low levels=Low risk

Conclusion: Low consumption of red & white wine & spirits NOT associated with increased risk Any consumption of beer/cider – IS associated with increased risk

Adverse Events in AF April 2021 Europace

Aim: Determine relationship between alcohol & AF-related adverse events in AF population

 9411 patients with NVAF in groups: Abstainer/Rare, Light, Moderate, Heavy

 Adverse events included: Ischaemic stroke, TIA, systemic embolic event, AF hospitalisation

Conclusion: Heavy alcohol considerably increases risk of adverse events, l-ight or moderate does not

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