AF a sobering thought

[Bagrat]

medscape.com/viewarticle/91...

This an excerpt from a study not yet published on Medscape as know some of you can't view it

COMMENTARY

A Sobering Breakthrough in AF Care

Dr John Mandrola

Results

On average, alcohol intake markedly decreased in the abstinence arm, but only 43 of 70 (61%) patients achieved complete abstinence; most (86%) cut their intake by more than 70%.

Even so, the first primary endpoint, time to AF recurrence, was reduced by 37% in the abstinence arm (P = .004). The second co-primary endpoint, mean AF burden, was also significantly reduced, and 46 patients in the abstinence group vs 25 in the control arm had 0% AF burden (P = .01).

Other good things happened: Body mass index and blood pressure were significantly reduced in the abstinence arm. The researchers used MRI to document statistically significant decreases in left atrial (LA) area and increases in LA emptying fraction in the abstinence arm.

They concluded that moderate alcohol consumption of more than 10 (standard) drinks per week is a potentially modifiable risk factor for AF. Abstinence (or a good attempt at it) was associated with reduction of AF burden, AF recurrence rates, reduction in AF symptoms, and improvement in weight loss and blood pressure.

Comments

What struck me most about Voskoboinik was his humility. In our interview and from the podium, he repeatedly and clearly noted the limitations of the study: It is not yet published, the patients were highly selected and motivated, not all patients had implantable loop recorders, and alcohol abstinence was confirmed mostly by self-report.

If more clinical scientists displayed this degree of humility about their work, science might have less issues with trust.

I look forward to the full paper, but plausibility and concordance with previous studies suggest these findings represent a true causal effect.

Observational data strongly associate alcohol intake—in a dose-dependent manner—with AF.[1] Alcohol exerts pro-fibrillatory autonomic,[2] electrical,[3] and structural[4] effects on the atrium. What's more, the observed effect in this study might have been larger had more participants been truly abstinent.

The findings of lower BP in the abstinence arm also aligns well with a recent systematic review showing that decreasing alcohol intake in people who drank more than two drinks per day was associated with significant blood pressure reduction.[5] And one hardly needs a reference to confirm that lower intake of carbohydrate-laden beverages would induce weight loss.

Voskoboinik concluded that reducing alcohol intake should be considered as part of the lifestyle intervention in moderate drinkers with AF.

I would go further. When this paper is published, it will create a bit of a moral challenge.

If the doctor and patient know that reduction of alcohol may eliminate AF, should that not be a mandatory first step before expensive and risky drugs or procedures are used? Given the vast inequities of access to healthcare, what would it say if we were ablating people so that they can continue drinking alcohol without experiencing AF?

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Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.

Cite this: John M. Mandrola. A Sobering Breakthrough in AF Care - Medscape - Mar 21, 2019.

[BobD Volunteer]

Not unexpected. I presume by drinks they mean units so an average glass of wine is two units usually or maybe 4 for a large glass?

[Auriculaire in reply to BobD]

I find that glass sizes and how much they are filled can vary a lot so as to only give a vague indication of how much one is consuming. For accuracy nothing beats a good old fashioned measuring jug to see how much that one glass of wine with dinner really is. Of course it would be a bit odd getting it out in a restaurant!

[2dekcol in reply to BobD]

I've been starting to notice palpitations the day or two after "drinking" more than a bit, so because I still like a drink most afternoons or evenings to wind down, I still make a drink---but a very small one. Only a dry red, now, to keep the sugar content low and because the reds are said to help the heart. I use an elegant little glass, which when full looks like a tiny full glass of wine, ha, ha. Had to give up scotch, my favourite drink, altogether. Let's face it, some things are more important than others. Good luck.

[rosyG]

very interesting fits in with people's experience on the forum too....

[Hidden]

Hear!Hear! I will drink to that -My sentiments entirely and l could not agree more....

[Paulbounce]

Excellent article - thanks for sharing.

Best,

Paul

[Stinky1953]

Very interesting. Thank you for sharing.

[Hidden]

Thank you - I was told to cut down on alcohol by my doctor when I first got AF - he said one of his patients always got AF when they'd had a bit to drink so this study makes sense. Incidentally, I've given up fizzy drinks recently and have found I'm having a lot fewer ectopics. Weird, eh?

[Bagrat in reply to Hidden]

Still trying to work out what triggers my ectopics. Havent found anything. 1 fizzy drink usually flattened by small gin twice a week doesn't seem to have an immediate response

[Eirecara]

Zero alcohol intake for me. Still the beast lingers ☘️

[Auriculaire]

Not that weird. Fizzy drinks are full of chemicals not to mention sugar. Overall they are probably worse for health than a small glass of red wine a day.

[Bagrat in reply to Auriculaire]

Agree the only fizz I have rately is fevertree.

[Auriculaire in reply to Bagrat]

What is that? Some sort of English champagne?

[Bagrat in reply to Auriculaire]

Brand of mixers with natural sugars, flavours and colouring. The aromatic tonic is lovely

[Gwersey]

I had one glass of wine at Christmas after 18 months abstinence. It tasted like nectar and didn't make ectopics worse. Was tempted to have a glass here and there since but haven't given in. But I do miss having a nice glass of red occasionally.

[doodle68]

Thanks for that Baggy I like Dr Mandrola.

[jedimasterlincoln]

Not really drunk alchohol much at all in the last 5 years. When I have done, it's usually made me feel on the edge of an AF episode so I've avoided it. I can't say I've missed the expense, the pointless void calories and the risk of an AF attack as a result.

In 2018 I only had 5 drinks in total.

[fairgo45]

Sorry for posting this a day later your responses are interesting