Impact of Alcohol Consumption on Substrate Remodeling and Ablation Outcome of Paroxysmal Atrial Fibrillation

Abstract

BackgroundThe effect of alcohol consumption on substrate remodeling and ablation outcome of paroxysmal atrial fibrillation (PAF) remains unknown.Methods and ResultsWe performed circumferential pulmonary vein isolation (CPVI) and voltage mapping of left atrium (LA) during sinus rhythm in 122 consecutive patients with symptomatic PAF (age, 55.4±9.4 years; 73.8% men). Low‐voltage zones (LVZs) were semiquantitatively estimated and presented as low‐voltage index (LVI). Each patient's daily alcohol consumption history was recorded at baseline and classified into alcohol abstainers, moderate drinkers, and heavy drinkers based on the National Institute on Alcohol Abuse and Alcoholism definition. Follow‐up was ≥12 months for AF recurrence. Alcohol abstainers and moderate and heavy drinkers were 70 (57.4%), 13 (10.6%), and 39 (32.0%), respectively. In total, LVZs were observed in 44 patients (36.1%). Daily alcohol consumption independently predicted presence of LVZs (odds ratio [OR], 1.097; 95% confidence interval [CI], 1.001–1.203; P=0.047). During mean follow‐up of 20.9±5.9 months, 40 patients (35.1%) experienced AF recurrence. Success rate was 81.3%, 69.2%, and 35.1% in alcohol abstainers, moderate drinkers, and heavy drinkers, respectively (overall log rank, P<0.001). Multivariate analysis showed that both alcohol consumption and LVI were independent predictors of AF recurrence (hazard ratio [HR], 1.579; 95% CI, 1.085–2.298; P=0.017; HR, 2.188; 95% CI, 1.582–3.026; P<0.001, respectively). Furthermore, mediation analysis revealed that LVZs acted as a partial mediator in effect of alcohol consumption on AF ablation outcomes.ConclusionsDaily alcohol consumption was associated with atrial remodelling, and heavy drinkers have substantial risk for AF recurrence after CPVI.

The roles of alcohol dehydrogenase in patients with atrial fibrillation

“…Left atrial diameters was the only cardiac parameter associated with the levels of alcohol consumption in the present study. Moderate to heavy drinking has been linked to an increase in the number of low voltage zones in the left atrium in a cohort study of patients with paroxysmal AF . In the same study, the left atrial diameter was not different between nondrinkers and drinkers, which might be due to the limitation of the small number of patient samples and the exclusive enrollment of patients with paroxysmal AF .…”

“…1 Alcohol consumption is known to increase the risk of AF and atrial remodeling, and has been associated with AF recurrence after catheter ablation in patients with paroxysmal AF in a small cohort study. [2][3][4][5][6][7] Ethanol is mainly metabolized by a two-step reaction involving alcohol dehydrogenase 1B (ADH1B) and aldehyde dehydrogenase (ALDH2). ADH1B converts ethanol to acetaldehyde, which is subsequently metabolized to acetate by ALDH2.…”

Does Moderate Drinking Increase the Risk of Atrial Fibrillation? The Norwegian HUNT (Nord‐Trøndelag Health) Study

“…Binge drinking is clearly an important trigger for AF . Short‐term, extensive alcohol consumption can trigger cardiac arrhythmias by altering the electrophysiological properties of the myocardium and influencing both sympathetic and parasympathetic activity .…”

Functional mitral regurgitation

“…[10,11] The LA were divided into 6 separated zones, which were the roof between the left superior pulmonary vein (LSPV) and right superior pulmonary vein (RSPV), anterior wall between roof and MVA, posterior wall between roof and MVA, lateral wall between left atrial appendage (LAA) and MVA containing the ridge between LAA and LSPV, floor, and septum between right PV antrum and floor (Supplemental Figure 1). Each zone involving LVZs was rendered 1 point.…”