Hello. This is Dr JoAnn Manson, professor of medicine at Harvard Medical School and Brigham and Women's Hospital in Boston, Massachusetts. I'd like to talk with you about a recent report in the New England Journal of Medicine that provides the most compelling evidence to date that alcohol consumption is causally related to atrial fibrillation (AF), and that by reducing or abstaining from alcohol, the burden from AF can be reduced.
Previous epidemiologic studies have shown evidence of a link between alcohol consumption and AF—even a dose-response gradient—but this is the first time that a randomized trial has shown that reducing alcohol consumption can lower the burden of AF.
This randomized trial was conducted in Australia. It was a small trial—only 140 participants—and all had to have at least two prior episodes of AF (either paroxysmal or persistent) and had to be in normal sinus rhythm at baseline, receiving rhythm-control therapy. About one third were post ablation therapy. They also had to have a moderate to high alcohol consumption. On average, they had about 17 drinks per week or a little more than two drinks per day. They had to agree to be randomized to modify their alcohol consumption.
One half were randomized to continue their usual alcohol intake and the other half had to abstain from alcohol. During the 6-month follow-up period, there was good separation between the two groups in terms of alcohol consumption. The control group continued to have an average of about two drinks per day (about 13 drinks per week) and the intervention group had on average about two drinks per week, and 61% were totally abstinent from alcohol consumption.
Over the follow-up period, there was a lower rate of AF occurrence, longer time to recurrence, lower overall burden of AF in terms of time in AF, and a lower rate of hospitalization for AF in the group that was randomized to abstain from alcohol and had lowered their alcohol intake.
This randomized trial provides strong evidence that alcohol consumption is a modifiable risk factor for AF and AF recurrence, and that it's important to counsel our patients about this association and encourage alcohol reduction in those with recurrent AF, especially those who have moderate to high alcohol consumption, and women in particular.
Women are known to have a higher risk for stroke from AF and a higher risk for cardiovascular disease mortality. Also, alcohol has been linked to an increased risk for breast cancer, and women have a greater susceptibility to liver disease. Women metabolize alcohol more slowly, so one drink a day in a man is the equivalent of two drinks a day in a woman. Although we may encourage all of our patients with AF and moderate to high alcohol intake to reduce alcohol consumption, this may be a particularly important message for women.
Thank you so much for your attention. This is JoAnn Manson.
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that was a snarky comment the more info the better about this issue many people still don't know or understand the correlation between the two information is power
Same here, being the daughter of an alcoholic I have never been what one would call a drinker but I did like the occasional glass of wine with my evening meal now and again. Twenty years ago I was diagnosed with P/A/F and and 12 years ago breast cancer so could that odd glass of wine be a factor I wonder?
I have been seeing the same excellent Cardiologist for about 6 years.At this year's routine check, for the very first time , he asked about my alcohol and coffee intake.
My reply " I have a cup of Decaff coffee at 11 most mornings and I never drink alcohol because I don't like it."
My trigger was the treatment for breast cancer which has a known high link to causing heart problems in long term survivors. I too drink a cup or maybe two perday of decaf coffee. The other day by mistake I drank a cup of ordinarly fliter coffee.....big mistake as hadnt realised it wasnt decaf. Boy did I know about it afterwards.....took over a day to settle!
Unfortunately, alcohol and AF don’t mix- the article confirms this. I have always wondered what the interval between alcohol consumption and PAF is? If you have gone, say, 10 hours after drinking without PAF(the time it takes for alcohol to pass through the body), does that mean that any subsequent PAF is not caused by the alcohol? Or can it impact even later on the system?
Based on everything I’ve read, heavy amounts of caffeine can be a trigger but smaller amounts may not be harmful. This may vary for each person.
My electrophysiologist advises me to avoid stimulants. Initially when she first treated me she said NO caffeine at all which was really hard for me. Later on I asked her if I could have a moderate amount of green tea daily and she said yes. She cited some research (which I also read) that MODERATE amounts of green tea can actually reduce AFib due to some health properties in the tea. So I replaced my excessive coffee habit with 1 tablespoon (2 grams) loose leaf green tea daily, and I get by.
For reference a mug (8 oz or 230 ml) of green tea might have 35mg caffeine. A tall Starbucks drip coffee (16 oz or 475 ml) has 220 mg caffeine.
Thank you for that. I have a mug of green tea (sometimes with pomegranate) about 4 times a week. I occasionally have decaf coffee with almond milk. Heart rate very rarely in the 60s. More usual in the 70s even when resting
I stopped alcohol 5/8/20 at age 73 after a catheter ablation. I had been a heavy drinker for 50 years. Just did not want beer or wine to trigger attacks and didn’t want to “waste” the benefits of ablation.
Quitting wasn’t as hard as expected, and I remained AFib free until last night. Extreme stress and tooth extraction and back pain all came together.
But I still agree quitting alcohol is a good thing. There are some great non alcoholic beers. And various fizzy waters.
Good for you Oldiemoldy. I’m sorry to hear of the recent episode and I hope it doesn’t recur. If you were still drinking heavily, it might have been worse. Best wishes to continued health.
That combination is lousy. So sorry, For backache have you tried getting a tennis ball and sitting or lying on it with it in the place that is most painful. You will know that you have it in the correct position cos it hurts most. When you are in pain it is because muscles have gone into spasm and the tennis ball stretches it and therefore eases it. Also gentle exercises. Good luck.
The alcohol issue is interesting but raises what should be a rather obvious further question...what, exactly, in the alcohol, is causing the afib? For example, if the sulfites in wine are causing it, very different than "alcohol" causing it. How about all the pesicide spray in napa valley? I would want to know what kind of wine...does organic wine trigger also? While abstaining from alcohol is probably easier, it does not really answer the question at all.
If women have a higher cardiovascular mortality it is probably due to the appalling bias shown towards women in diagnosis and treatment of heart disease. Many studies have shown that womens concerns with chest pain and tachy are more likely than men's to be dismissed as "anxiety" in ER evaluations with many women being sent home to suffer and die from a major heart attack. Women are less likely to get aggressive interventions than men. Women are less likely to be given proper pain relief etc etc. As for alcohol I have reduced intake to one very small glass of wine with main meal. When at a restaurant we share a half bottle . Often we cannot finish it. There does not seem to be any difference in the afib but I definitely feel tipsy sometimes after the quarter bottle when we do finish it!.
Thanks for posting. Love to read this kid of actionable information and research here.
I am just a sample size of one, but I (50M) can’t help wonder if my over-drinking during college and my early twenties, followed by too many years of “moderate” drinking (1-2 drinks most days), didn’t contribute to the paroxysmal AFib I developed in my late 40s, even though I was otherwise fairly healthy and had reduced my drinking in my mid-40s down to a couple of drinks per month even before I got AFib. Maybe the damage was already done? We will never know.
At any rate, I’ve been alcohol-free 9+ months and while I do miss the occasional beer or glass of wine, I just don’t want to take the risk. I’ve been AFib-free for 4 months since my first ablation and I want to minimize the chance of AFib coming back.
Incidentally, I think I’m much better off sober, mentally and physically. If I can survive booze-free, you can too.
My alcohol consumption has been very light over the years, but even one drink now certainly increases my ectopics and episodes of P-AF. Thank you for the valuable information in your post.
Thank you this is very informative, I am very appreciative of your time to provide us with this.
I would really like to know why? Treatment for all Arrhythmia tends to be for the symptoms (I know this may well be driven by by profit), why does alcohol (or could it be something else such as nitrates in the drink) have such an effect, if we could get to the bottom of this we will be a step closer in knowing the real cause.
Interesting post. I haven’t ever been a heavy drinker but used to like an occasional glass of wine, mainly red. A few years’ ago, after I had been diagnosed with AF and been prescribed Bisoprolol, I did ask my then GP if it was OK to drink alcohol. His reply, “Yes, fine, drink as much as you like!” As you can imagine, I was rather astounded by this reply and have not acted on it. Rather the reverse, I have more or less given up alcohol although still tempted on very rare occasions when out for a meal.
I’m post ablation - only five weeks - and stopped drinking alcohol and caffeine and I am still getting three AF’s a week. If I had continued with a wine with dinner and a cuppa or two in the morning would I have been getting even more AF’s a week? At times I feel like declaring a pity party.
Thank you for posting this. Another whole area is our exposure to electromagnetic fields of radiation with the exponential increase in cellular technology and wifi usage. If you use a cell phone regularly or live near a cell tower or mast or are exposed to other types of fields, it causes arrhythmias and fib. My paf episodes have decreased dramatically since changing my environmental exposure..
When home from the hospital with my new diagnosis of a fib,,,,,I listened to my MD and immediately cut out as many sources of caffeine as I could,,,,and gave up alcohol totally,,,albeit I had been a social drinker with 1 or 2 glasses of wine per month,,,,in almost 4 years now I have never had another incidence of afib that is am aware of,,,I am on a beta blocker and warfarin,,,,,I consider myself extremely fortunate and hope I can continue this way ,,I am almost 73 and have other issues to be concerned about,,,so I don’t need a fib,for sure!
I was never a great drinker- a small glass of wine with the evening meal- and I had always been fit and healthy prior to diagnosis. The only way I could cut down on alcohol was to give up entirely which I have done. Similarly, I have not had coffee or ordinary tea for many years, preferring herbal teas. But I still get AF episodes every few days and though they do not last long with flecainide as PIP, it is unsettling. I do wish that you guys would realise that we are all different and also that drugs should be available in very different dosages and not just suitable for the average male! Certainly your research may well be of value in Australia where I understand there is great enthusiasm for alcohol but all women are not like that!!!
Def agree that the dosage of drugs should not be for the average male. If anything I am a bit underweight and female so I always feel that the dosages I am given are probably way too high.
I have mainly come across it in relation to anticoagulants, as this is my first health problem- a friend coined the wonderful phrase that she "looked like a victim of domestic violence" after having been put on the "normal" dose even though she is a pretty slight woman. I weigh a little over the 60kg when the package info says one should be given half the dose so have persuaded the nice new young GP at my practice that is quite enough for me, especially since he has found one that I only need to take once a day and doesn't give me diarrhoea as Rivaroxiban did and like "the pill", has the days marked (in several languages)!
As I've been going on about this for a while my son gave me a copy of Invisible Women by Caroline Criado Perez for my birthday and that has a section on Going to the Doctor! The introduction to the book is called "The default male" which I remember well from the time I was called back to the surgery after returning home from a lung capacity test, as the nurse had forgotten to change the setting from the default male!
Thanks for sharing that. I gave up alcohol over 4 yr ago when diagnosed, at the advice of my EP. Happily my a fib has become more and more infrequent. I did sneak a beer a month ago or so... it tasted great but no a fib tastes better💜
The fact is that whilst alcohol may affect some people and I understand that the female of the species generally is affected more than the male you can still have AF if you never touch the stuff. If it does affect you then stopping is obviously a wise thing to do but you may well still have AF. Triggers are only triggers not causes.
I totally agree with Bob. The only trigger I know that has caused episodes of AF is swimming, and not always. I am fit, 70 years old, go to the gym three times a week. I drink a couple of cans of lager every night, often more. I also drink at least one cup of coffee and two cups of tea a day. Now this may not be good for me in other ways but it certainly doesn't bring on AF. Well not yet anyway. If it did I would not be stupid enough to continue (I hope). I realise that I am probably very lucky so far, but that's the way it is at the moment.
JoAnn - most of this we already knew (because alcohol causes dehydration). Here is some info I bet you didn't know:
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After 9 years of trying different foods and logging EVERYTHING I ate, I found sugar (and to a lesser degree, salt – i.e. dehydration) was triggering my Afib. Doctors don't want to hear this - there is no money in telling patients to eat less sugar. Each person has a different sugar threshold - and it changes as you get older, so you need to count every gram of sugar you eat every day (including natural sugars in fruits, etc.). My tolerance level was 190 grams of sugar per day 8 years ago, 85 grams a year and a half ago, and 60 grams today, so AFIB episodes are more frequent and last longer (this is why all doctors agree that afib gets worse as you get older). If you keep your intake of sugar below your threshold level your AFIB will not happen again (easier said than done of course). It's not the food - it's the sugar (or salt - see below) IN the food that's causing your problems. Try it and you will see - should only take you 1 or 2 months of trial-and-error to find your threshold level. And for the record - ALL sugars are treated the same (honey, refined, agave, natural sugars in fruits, etc.). I successfully triggered AFIB by eating a bunch of plums and peaches one day just to test it out. In addition, I have noticed that moderate (afternoon) exercise (7-mile bike ride or 5-mile hike in the park) often puts my Afib heart back in to normal rhythm a couple hours later. Don’t know why – perhaps you burn off the excess sugars in your blood/muscles or sweat out excess salt?? I also found that strenuous exercise does no good – perhaps you make yourself dehydrated??
I'm pretty sure that Afib is caused by a gland(s) - like the Pancreas, Thyroid (sends signals to the heart to increase speed or strength of beat), Adrenal Gland (sends signals to increase heart rate), Sympathetic Nerve (increases heart rate) or Vagus Nerve (decreases heart rate), Hypothalamus Gland or others - or an organ that, in our old age, is not working well anymore and excess sugar or dehydration is causing them to send mixed signals to the heart - for example telling the heart to beat fast and slow at the same time - which causes it to skip beats, etc. I can't prove that (and neither can my doctors), but I have a very strong suspicion that that is the root cause of our Afib problems. I am working on this with a Nutritionist and hope to get some definitive proof in a few months.
Also, in addition to sugar, if you are dehydrated - this will trigger AFIB as well. It seems (but I have no proof of this) that a little uptick of salt in your blood is being treated the same as an uptick of sugar - both cause AFIB episodes. (I’m not a doctor – it may be the sugar in your muscles/organs and not in your blood, don’t know). In any case you have to keep hydrated, and not eat too much salt. The root problem is that our bodies are not processing sugar/salt properly and no doctor knows why, but the AFIB seems to be a symptom of this and not the primary problem, but medicine is not advanced enough to know the core reason that causes AFIB at this time. You can have a healthy heart and still have Afib – something inside us is triggering it when we eat too much sugar or get (even a little) dehydrated. Find out the core reason for this and you will be a millionaire and make the cover of Time Magazine! Good luck! - Rick Hyer
PS – there is a study backing up this data you can view at:
The above info is fact - proven hundreds of times. Below is NOT facts - only what I suspect is really going on with Afib patients:
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I have always thought all Afib patients have a similar problem happening within our bodies that is causing our afib problems. After 17 years of watching my afib come and go, and logging everything I eat, I am pretty sure our hearts are fine but we have a problem with a gland(s) or an organ(s). For example:
1). The Sympathetic Nerve INCREASES the heart rate.
2). The Vagus Nerve DECREASES the heart rate.
3). The Adrenal Gland INCREASES the heart rate (with adrenaline), heightens
anxiety.
4). The Thyroid Gland both DECREASES and INCREASES the heart rate, and
heart strength.
5). The Hypothalamus Gland produces hormones directing other glands to do
stuff.
6). The Pancreas processes sugar, which cause other glands to do different
things.
7). To further complicate the situation, when one gland stops working, sometimes another gland will try to pick up the slack.
Plus - there are lots more glands in the body, plus don't forget the organs, which (some) also influence the heart rate, for example:
Medulla in Brain: Heart rate can be increased or decreased by impulses brought to
the SAN or AVN by nerves originating in the medulla oblongata of the brain.
The endocrine system of gland processing is complex – it’s a wonder it works at all.
For a neat picture/information on all the glands, check out this URL: (Ctrl and click):
Medications, chemicals, foods etc. can all cause our glands and organs to mis-fire. For me, sugar (and dehydration) are causing some gland(s) or organ(s) in my body to mis-fire, sending mixed signals to the heart - for example, telling the heart to beat fast and slow at the same time. This would explain why a healthy heart sometimes beats abnormally. It also explains why my heart afibs when I eat too much sugar, because the heart does NOT use sugar to contract (uses fatty acids) so obviously sugar/dehydration is causing something to misfire which in turn is directing the heart to afib. In our old age, I suspect a gland or organ is not working as it used to, causing afib or other heart palpitations. Unfortunately doctors and researchers don't know what it is (yet). In the meantime we will have to listen to our bodies VERY closely to see what is causing our problems and reduce or eliminate our afib by reducing what triggers it.
Sugar triggering my Afib has been proven hundreds of times (by myself and others) but no "scientific" study done on it at this time (wish there was). As far as the glands causing Afib - that is just my best guess as to what is going on. One thing for sure - sugar causes my afib, and the heart does NOT use sugar to contract (uses fats), so obviously there is something else in the body that is telling the heart to beat fast/slow when that something else gets an overload of sugar. So it's definitely NOT the heart doing it on it's own - something else is (mistakenly) telling it to. NEED RESEARCH ON GLANDS!!!!
- Rick Hyer.
• in reply to
I'm wondering about starch, which is broken down into simple sugars in the earliest stages of digestion
• in reply to
I would think anything you eat that is converted into sugar would contribute to your sugar load. I have not kept track of that stuff, mainly because nobody can tell me how many grams of sugar is created by the different foods (each is different and each take different amounts of time to convert to sugars). Even steak is eventually converted to some sugars in your body. So . . . I just have been counting the direct sugars in everything I eat - like 20 grams of sugar in an apple, 17 grams in a banana, etc.
- Rick Hyer.
• in reply to
Diabetics have to calculate their carbohydrate intake in order to maintain the correct balance. Just adding up simple sugar intake is meaningless, so I am afraid I could not place any trust in the sugarisit argument
Salt definitely causes dehydration. Remember - drink too much sea water and you will die of dehydration. Sweating and not drinking also causes dehydration because the salt concentration in your blood increases as you use up water.
Salt does not Definately cause dehydration. It is completely dependant on the circumstances. Assuming an otherwise healthy person (which is nowadays a big assumption) ingesting salt in and of itself will not cause dehydration. It should, under normal circumstances, make one ingest more fluid as our body attempts to maintain balance. If, on the otherhand, someone has high blood pressure and they are fluid restricted and ingesting salt at the same time, in order to maintain homeostasis, fluid will come in from the tissues and then be excreted...this can cause dehydration. Not, the salt per se. If you are dehydrated and in the hospital, you will be given Normal Saline most likely which is sodium chloride (Salt) in water...I have low blood pressure, no atherosclerosis but do have PAF. Ingesting salt is fine as long as I make sure that I am drinking plenty of fluids along with it. Since I will get thirsty if I ingest salt...that is not a problem for me. Again...depends totally on the person, medical condition and circumstances.
Ingesting salt is OK as long as you don't overdue it. Eat too much of it and your body thinks it's dehydrated because the salt content in your blood becomes too concentrated. Ask any doctor.
I am afraid I already discovered this myself. I only had a small glass when preparing dinner and perhaps another half with dinner to help me as its very effective taming essential tremor for a few hours, without the side effects of medication used for ET. Bad news is it has set off my AFib/Aflutter since my recent pacemaker insertion . So no alcohol, (and it seems to be working) but dinner prep is tough and dinner is worse. Upside...losing a few pounds. These are not the golden years I had hoped for. And no, the non alcoholic wines are no answer...ET required the alcohol. Doc actually recommended it☹️.
I've been lurking here for a while, but thought I'd actually say something for a change. I'm 64, female, a retired nurse, overweight and have T2 diabetes (diagnosed in 2018 and now in remission and losing weight thanks to a low carb diet).
I've also had paroxysmal AF for 14 years. Initially I had episodes fairly frequently, but never been cardioverted, just took propafenone, bisoprolil and warfarin (changed to apixaban two years ago). Initially I stopped all caffeine and alcohol, and over the next few years the episodes became less frequent and were of much shorter duration. I could live with them. Now I still don't drink caffeine at all, but about four years ago, I started to have a gin and slimline tonic on a few nights a week - this was always my tipple of choice. At the same time, I started taking magnesium religiously every day and it is now over three years since I had an episode of AF of which I've been aware. One diagnosis but we're all different, I suppose!
It seems that different things can cause different people to afib. But I still believe it (probably) is the same gland in each of us that is not working correctly when it sees too much of our trigger introduced. Wish we could get someone to do some research on that (on gland function and misfunction) - shouldn't be too hard to do - just measure the output of my gland(s) when I am beating normally, then measure again after consuming sugars.\
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Alcohol and Afib
AF with Red wine 
My PAF returned and it was entirely my fault! 
Alcohol after Cardioversion. They suspect there's a risk but don't tell you.
