The Sobering Truth: Alcohol and Atrial Fibrillation


Atrial fibrillation (AFib) is a heart disorder caused by the abnormal beating of the heart’s upper chambers (atria). It is a condition that affects over 33 million people worldwide, and is the leading cause of stroke. In fact, AFib patients are five times more likely to suffer from a stroke.

While we are on the subject, there is good news, and bad news.

The good news is that doctors support the popular notion that there are heart health benefits associated with light drinking…

The bad news is that those benefits don’t extend to patients with AFib.

The link between alcohol consumption and AFib is well-documented. The term “Holiday Heart Syndrome” was first coined in 1978 by a doctor who had 24 patients hospitalized with AFib after a weekend of binge drinking. While many of these patients were regular drinkers, subsequent research has shown that AFib episodes occur even in non-drinkers after binge drinking.

So let’s face the sobering truth: If you have AFib, then drinking alcohol, even in moderation, can have negative impacts on your heart health.

I drink in moderation, but what is moderate drinking?

Moderate alcohol consumption is defined as an average of one to two drinks per day for men and one drink per day for women. Given that different drinks have varying percentages of alcohol, by this definition, a ‘drink’ is either one 350-ml regular beer, one glass of wine, or roughly 45 ml of hard liquor like vodka, whiskey or gin.

By this standard, even moderate alcohol consumption can affect AFib in the following ways:

  • It can turn paroxysmal AFib to persistent AFib
  • It can trigger AFib symptoms
  • It increase the likelihood of symptoms returning after a heart surgery

You can find out more about AFib and its management here.

How does alcohol affect my heart?

Typically, the effect of alcohol on your symptoms and heart health depends on the quantity of alcoholic drinks, how often you drink, and your medication regimen.

  1. Alcohol affects vagal nerve activity:

The vagal nerve carries information between the brain and the internal organs. It runs like a sort of ‘super highway’ through the neck, extending from the brain all the way down the torso, connecting with key organs like the brain and heart along the way down. Alcohol causes a spike in vagal nerve activity, and this increase in nerve response can trigger an AFib event.

  1. Alcohol affects fluid levels:

Alcohol is a diuretic, meaning it causes your body to expel more water, which often results in dehydration. Imbalance in fluid levels and dehydration can be a trigger for an AFib episode.

  1. Alcohol can interact with prescription medication:

Similar to how medications can interact with one another, alcohol can interact with heart medication – including the ones you take to manage AFib. Alcohol consumption while taking blood thinners like warfarin can be especially dangerous because they can increase the risk of excessive bleeding.

Let’s examine the science

Research published in 2020, in the New England Journal of Medicine, examined the effect of modifying alcohol intake in AFib patients. To be eligible for the study, participants had to already be moderate alcohol consumers (‘moderate’ being 10 or more standard drinks a week). Once enrolled, patients were randomly assigned to either continue drinking as they normally would, or to abstain entirely from alcohol for a period of six months. The initial study plan involved a follow-up for one year but there were very few volunteers willing to give up alcohol for that long!

All study participants were required to send an electrocardiogram (ECG) twice a day using AliveCor’s KardiaMobile, a personal ECG device that syncs with your smartphone. Taking the ECG readings took 30 seconds, and doctors could receive these ECG readings instantly. If they experienced any symptoms, they were required to send additional ECG readings during and after those symptoms as well.

After a period of 6 months, researchers found that participants who abstained from alcohol went an average of 118 days without any irregular heart rhythm, compared to 86 days for those who continued drinking. This variation translated to a 37% improvement in AFib recurrence among those who did not drink alcohol. By the end of the study, at the six-month mark, those that drank spent 1.2% of the time in AFib vs. those that did not drink, who spent only 0.5% of the time in AFib. Additionally,  they found that no drinking was associated with weight loss and other health benefits: The non-drinkers lost an average of 8 pounds more than the drinkers and saw a significant drop in blood pressure.

A much larger analysis of multiple research studies spanning over 850,000 patients found that for each extra alcoholic drink per day, AFiB incidence increased 8%.

How Do I Find a Balance?

We understand that for some people it may be unrealistic to expect abstinence from alcohol, and the good news is that you don’t have to go completely cold turkey. You can find a balance!

  1. Is drinking part of your daily relaxation routine? Maybe take a dry day: If you generally drink on a daily basis, try marking out a few days in the week that are alcohol-free, or ‘dry days’. While it’s established that binge drinking is harmful, moderate drinking can contribute to AFib and a worsening of symptoms. If you tend to have a drink in the evenings, find a substitute like herbal tea or coffee instead.
  2. Are you also dealing with other heart conditions? Be extra vigilant: Pay attention to your heart rate, ECG readings and blood pressure, if it is possible to track all those on a regular basis. This is especially important since alcohol can cause a blood pressure spike.
  3. Does drinking make you feel extra thirsty? Stay hydrated: Since alcohol consumption causes dehydration, ensure that you are not losing more water than you gain. Make sure you drink plenty of water, or a beverage with electrolytes to ensure that you stay on top of your fluid and mineral intake.
  4. One for the road? Maybe not: Choose to skip the last drink, especially one just before bedtime. Good quality sleep is linked to stress levels and directly impacts AFib episodes. Alcohol can interfere with normal sleep patterns.

Remember, as with most things, moderation is key. Alcohol intake is just one of many heart-healthy lifestyle changes that you can make. The bonus is that typically, one positive change paves the way for the next. For example, choosing to exercise on a regular basis may mean that you will need to wake up earlier, so you may anyway choose to skip the late-night drinking session. A healthy diet can mean excluding fried snacks, or typical ‘chakna’ that goes with your favorite alcoholic beverage. Also, many of these lifestyle changes cause a reduction in weight and stress levels.

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