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The question: I have been diagnosed with a heart rhythm problem called atrial fibrillation. My doctor says alcohol makes it worse. Do I have to give up drinking?

The answer: Doctors have long known that binge drinking can trigger episodes of atrial fibrillation, or A-fib. An excessive amount of alcohol in a very brief period of time disrupts heart function – even in relatively healthy people.

The medical profession has dubbed the condition “holiday-heart syndrome” because binge drinking tends to happen on weekends and holidays.

However, a growing body of research suggests that even moderate drinking – as little as one glass of wine or a bottle of beer – can trigger A-fib in people who are susceptible to the heart rhythm disorder.

To better understand the risk, it is worthwhile reviewing what actually happens during atrial fibrillation.

Normally, the various chambers of the heart work in a co-ordinated and systematic fashion in order to distribute oxygenated blood throughout the body. The heart’s electrical system controls the contractions.

But in the case A-fib, the heart’s upper chambers (atria), which are responsible for pushing blood into the two lower chambers (ventricles), contract in a rapid and chaotic manner.

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Essentially, the heart’s electrical system is malfunctioning. “You get impulses from all different areas of the top chamber of your heart,” explains Tara O’Brien, a general internist at Women’s College Hospital in Toronto. “So variable amounts of blood are being pushed to the bottom chambers.”

People experience these irregular heartbeats in various ways. They may feel chest discomfort, heart palpitations, shortness of breath and might even faint. And yet some of these individuals don’t notice anything out of the ordinary, except for occasional bouts of fatigue.

Initially, the episodes may last for a few minutes or several hours. Over time, though, they often progress to persistent atrial fibrillation, in which the abnormal rhythm continues for prolonged periods and may become permanent, Dr. O’Brien says.

Left untreated, A-fib can have catastrophic consequences. The chaotic contractions can cause some blood to stagnate, or collect, in the heart chambers. This, in turn, can lead to the formation of blood clots, which can then travel to the brain and result in a stroke. In fact, about a quarter of strokes in people over 50 years of age are linked to A-fib.

It can also result in heart failure, where this vital organ is unable to supply the body with sufficient amounts of oxygenated blood.

The risk of developing A-fib increases with age. About 2 per cent of people under 65 years of age have A-fib, while 9 per cent of those over 65 have it. And, in the over 80 group, the prevalence jumps to 15 per cent, Dr. O’Brien says.

Numerous medical conditions may disrupt the normal electrical activity of the heart and can lead to A-fib – including high blood pressure, diabetes, sleep apnea and obesity.

Those who already have the condition are extremely sensitive to the effects of alcohol. “It makes heart muscle cells more excitable, and more vulnerable to contract from any trigger,” says Eugene Crystal, a cardiologist at Sunnybrook Health Sciences Centre in Toronto.

A U.S. study published in August in the Annals of Internal Medicine found that one alcoholic drink doubled a A-fib patient’s chance of having an episode within several hours.

Atrial fibrillation is treated with various medications that help normalize the heart rhythm. As well, anticoagulants, or anti-clotting drugs, are often prescribed to reduce the risk of strokes.

Some patients may require invasive medical procedures such as ablation, in which misfiring electrical cells are destroyed.

Dr. Crystal points out that these treatments will be less effective in patients who continue to drink alcohol on a regular basis.

And, for that reason, an increasing number of physicians are urging their A-fib patients to avoid alcohol completely.

“I used to tell them to cut back on alcohol intake. Now I recommend abstinence,” Dr. O’Brien says.

She changed her advice after a landmark Australian study published in the New England Journal of Medicine in January 2020.

That randomized controlled trial clearly demonstrated the benefits of eliminating alcohol to the greatest extent possible. “The drinkers spent more than twice as much time in atrial fibrillation, compared to the non-drinkers,” Dr. O’Brien says.

Doctors readily concede that many patients don’t welcome the news that they need to stop drinking alcohol. “It’s a hard choice for some people,” Dr. Crystal says. Even so, he urges patients to “try abstinence and see if it improves your A-fib.”

If giving up all alcohol is too difficult to do, then at least cut back. “The bottom line is that less is better,” Dr. O’Brien says.

There is a popular belief – or possibly misconception – that drinking is good for the heart. But when it comes to atrial fibrillation, especially for people who have a history of the condition, nothing could be further from the truth.

Paul Taylor is a former Patient Navigation Adviser at Sunnybrook Health Sciences Centre and former health editor of The Globe and Mail.

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