Alcohol abstinence may reduce secondary atrial fibrillation, randomized trial finds

An editorial noted the potential difficulty of convincing patients who drink regularly to abstain from alcohol long enough to make a difference.


Abstinence from alcohol reduced secondary atrial fibrillation in regular drinkers, a small Australian study found.

Researchers conducted a multicenter, open-label, randomized controlled trial at six hospitals among adults who consumed 10 or more standard drinks (one standard drink was defined as 12 g of pure alcohol) per week and who had paroxysmal or persistent atrial fibrillation in sinus rhythm at baseline. One hundred forty patients were randomly assigned in a 1:1 ratio to either abstain from alcohol or continue their usual consumption. Patients were asked to report their alcohol consumption during the trial by maintaining a weekly alcohol diary. Those in the abstinence group were encouraged to abstain completely, got monthly oral and written advice on abstaining from study investigators, and could receive random urine testing to confirm abstention if no alcohol use was logged in their diaries. Primary end points were recurrence of atrial fibrillation and proportion of time in atrial fibrillation during six months of follow-up. Results of the study were published Jan. 2 by the New England Journal of Medicine.

Eighty-five percent of the study patients were men, and the mean age was 62 years. The 70 patients assigned to the abstinence group reduced their mean alcohol intake from 16.8±7.7 to 2.1±3.7 standard drinks per week (a reduction of 87.5%), while the 70 patients assigned to the control group reduced their mean alcohol intake from 16.4±6.9 to 13.2±6.5 drinks per week (a reduction of 19.5%). After a two-week blanking period, atrial fibrillation recurred in 37 (53%) of 70 patients in the abstinence group and in 51 (73%) of 70 patients in the control group. Time without recurrence of atrial fibrillation was longer in the abstinence group than in the control group (hazard ratio, 0.55; 95% CI, 0.36 to 0.84; P=0.005), and the median percentage of time in atrial fibrillation during six months of follow-up was significantly lower in the abstinence group than in the control group (0.5% vs. 1.2%; P=0.01).

An editorial noted that researchers shortened the abstinence group's follow-up to six months from a planned 12 months because of challenges in recruiting participants willing to abstain from alcohol for a year. It added that alcohol consumption is strongly embedded in the food and societal culture of Westernized countries. The editorial stated, “[T]he current study presents a compelling argument for alcohol abstinence as part of the successful management of atrial fibrillation. Nevertheless, the sobering reality is that for many persons with atrial fibrillation, total abstinence from alcohol may be a difficult goal to achieve.”