From the Guidelines
Drinking alcohol can significantly exacerbate atrial fibrillation (AFib) and increase the risk of hospitalization, and therefore, it is recommended to limit alcohol consumption to ≤3 standard drinks (≤30 grams of alcohol) per week or consider abstinence. According to the 2024 ESC guidelines for the management of atrial fibrillation 1, alcohol consumption can increase the risk of adverse events in patients with AF, such as thromboembolism, death, or AF-related hospitalization.
The effects of alcohol on AFib can be broken down into several key points:
- Alcohol disrupts the heart's normal rhythm, increasing the risk of AFib episodes or making existing ones more severe 1
- Alcohol consumption is associated with a dose-dependent increase in the recurrence of AF after catheter ablation 1
- Reducing alcohol consumption to ≤7 standard drinks (≤70 grams of alcohol) per week can improve maintenance of sinus rhythm in patients undergoing catheter ablation 1
- Alcohol excess is associated with a greater risk of bleeding in patients receiving oral anticoagulation (OAC), mediated by poor adherence, alcohol–drug interactions, liver disease, and variceal bleeding 1
Given the potential risks, it is essential for patients with AFib to discuss their alcohol consumption with their cardiologist to determine the best course of action for their specific condition. The 2024 ESC guidelines also recommend reducing alcohol consumption as part of comprehensive risk factor management to reduce AF recurrence 1.
In terms of specific recommendations, limiting alcohol consumption to ≤3 standard drinks (≤30 grams of alcohol) per week is recommended 1. However, abstinence may be the best option for some patients, particularly those with a history of heavy drinking or those who experience severe AFib symptoms after consuming alcohol. Ultimately, the decision to limit or avoid alcohol should be made in consultation with a cardiologist, taking into account the individual patient's risk factors and medical history.
From the Research
Alcohol Consumption and Atrial Fibrillation
- Moderate to heavy alcohol use is associated with the development of atrial fibrillation (AFib) 2
- The term "holiday heart" was coined to describe patients who had AFib following binge alcohol use, highlighting the link between alcohol consumption and AFib 2
- Excessive alcohol consumption is associated with incident AFib and adverse atrial remodeling 3, 4
Mechanisms and Risk Factors
- Acute alcohol consumption can trigger AFib by changing electrophysiological parameters, autonomic tone, and cellular properties 4
- Habitual alcohol consumption is associated with adverse atrial remodeling, higher risk of incident AFib, and AFib recurrence 4
- Alcohol intake is positively associated with atrial flutter (AFL) in younger patients, potentially due to a shortening of the right atrial effective refractory period 5
Reducing Alcohol Consumption and AFib Risk
- Reducing excessive alcohol consumption may reduce the risk of recurrent AFib episodes and AFib burden 3, 4
- Abstinence from alcohol can reduce arrhythmia recurrences in regular drinkers with AFib 3
- Patients with AFib should be advised to limit their alcohol use to reduce the risk of AFib recurrence and hospitalization 2, 3, 4