Alcohol Abstinence to Treat Atrial Fibrillation

Both alcohol withdrawal and heavy drinking can trigger atrial fibrillation, but it is not known whether abstinence would reduce the occurrence of atrial fibrillation among people who drink regularly. Investigators studied 140 patients (85% male) with paroxysmal or persistent atrial fibrillation who were drinking an average of 17 drinks* per week and were willing to consider abstinence. Participants in normal sinus rhythm were randomized to either encouragement to abstain (with monthly communication to assess adherence and provide positive reinforcement), or to continue their usual alcohol consumption. Patients with alcohol use disorder were excluded from the trial.

• The 70 patients in the abstinence group reduced their drinking to a mean of 2 drinks per week; 61% achieved abstinence and 76% drank ≤2 drinks per week. In the control group, drinking declined to 13 drinks per week.
• After two initial weeks in which outcomes were not assessed, atrial fibrillation recurred in 53% of the abstinence group and 73% of the control group. Median time in atrial fibrillation was 0.5% and 1.2%, respectively.

* US standard drink = 12 g alcohol.

Comments: Abstinence may be difficult to achieve for those with alcohol use disorder and an inability to stop drinking despite wanting to do so. But for those without alcohol use disorder who are willing to abstain, have a reason (atrial fibrillation) to abstain, and are encouraged to abstain, they can do so and reap the benefits of less atrial fibrillation.

Richard Saitz, MD, MPH

Reference: Voskoboinik A, Kalman JM, De Silva A, et al. Alcohol abstinence in drinkers with atrial fibrillation. N Engl J Med. 2020;328:20–28.