Written by Jonathan M Kalman MBBS, FRACP, PhD, FACC

Although the relationship between binge drinking and atrial arrhythmias has been recognized for decades, there are emerging data that regular alcohol consumption, even at mild to moderate levels, may predispose individuals to atrial fibrillation (AF).

This comprehensive review explores potential pathophysiological mechanisms for this association, including effects on ion channels, the autonomic nervous system, interaction with other AF risk factors (eg, hypertension and obstructive sleep apnea), and possible direct toxicity leading to atrial fibrosis.

While small amounts of alcohol may protect against other forms of cardiovascular diseases, those with a history of AF may be at increased risk of recurrence with regular alcohol consumption. Patients with a history of AF should be asked about alcohol intake and counseled that, based on current literature, even modest alcohol intake may be detrimental.

Further research will be required to determine whether there is a safe level of alcohol intake in patients predisposed to AF.

Abstract

Alcohol is popular in Western culture, supported by a perception that modest intake is cardioprotective. However, excessive drinking has detrimental implications for cardiovascular disease.

Atrial fibrillation (AF) following an alcohol binge or the "holiday heart syndrome" is well characterized. However, more modest levels of alcohol intake on a regular basis may also increase the risk of AF.

The pathophysiological mechanisms responsible for the relationship between alcohol and AF may include direct toxicity and alcohol's contribution to obesity, sleep-disordered breathing, and hypertension.

We aim to provide a comprehensive review of the epidemiology and pathophysiology by which alcohol may be responsible for AF and determine whether alcohol abstinence is required for patients with AF.