“…Even though, in principle, observational studies do not allow for proof of causality, there are several theoretically plausible speculations for the cause-effect relationship between high alcohol intake and the development of AF. One speculation is based on biological findings that suggest a harmful effect of high alcohol intake on maintenance of normal heart rhythm, including the achievement of a hyperadrenergic state (32), impairment of vagal tone (33), direct effect on myocardial structure (34), and various electrophysiological changes in atrial cells (e.g., increase in intra-atrial conduction time represented by a length of the P-wave, reduction in the refractory period, negative inotropic effect through calcium-channel inhibition in ventricular cells) (31,35,36).…”