Moderate alcohol consumption is associated with atrial electrical and structural changes: Insights from high-density left atrial electroanatomic mapping

Voskoboinik, Aleksandr; Wong, G.; Lee, Geoff; Nalliah, C.; Hawson, Joshua; Prabhu, Sandeep; Sugumar, Hariharan; Ling, Liang‐Han; McLellan, A.; Morton, Joseph B.; Kalman, Jonathan M.; Kistler, Peter M.

doi:10.1016/j.hrthm.2018.10.041

Cited by 78 publications

(43 citation statements)

References 28 publications

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“…For low alcohol intake there was no associated risk of AF 31. A recent publication has demonstrated regular moderate alcohol consumption was associated lower atrial voltage and conduction slowing suggesting these electrical and structural changes may explain AF at this level of consumption 32. These studies while heterogeneous do demonstrate a direct influence of alcohol as a risk factor for the development of AF.…”

Section: Alcoholmentioning

confidence: 82%

Lifestyle modifications for treatment of atrial fibrillation

Middeldorp

Ariyaratnam

Lau

et al. 2019

Heart

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The management of atrial fibrillation (AF) has focused on anticoagulation, rhythm control and ventricular rate control. Recently, a fourth pillar of AF management has been incorporated recognising the importance of risk factor management (RFM). There are several risk factors that contribute to the development and progression of AF, these include traditional risk factors such as age, hypertension, heart failure, diabetes and valvular heart disease. However, increasingly it is recognised that obesity, sleep apnoea, hyperlipidaemia, smoking, alcohol, physical inactivity, genetics, aortic stiffness are associated with the development of AF. Importantly, several of these risk factors are modifiable. We have seen the evolution of RFM programmes which have demonstrated promising results. Indeed, the evidence is now so compelling that major clinical guidelines strongly advocate that aggressive treatment of these risk factors as a key component of AF management. Patients with AF who comprehensively managed their risk factors demonstrate greater reduction in symptoms, AF burden, more successful ablations and improved outcomes with greater AF freedom. In this article, we will review the evidence for the association between cardiac risk factors and AF and assess the burgeoning evidence for improved AF outcomes associated with aggressive cardiac RFM.

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Section: Alcoholmentioning

confidence: 82%

Lifestyle modifications for treatment of atrial fibrillation

Middeldorp

Ariyaratnam

Lau

et al. 2019

Heart

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“…Indeed, moderate drinking as well as binge drinking predispose to AF 17 . Moderate alcohol consumption has been associated with large left atrial scar burden 38 , and frequent drinking and the total amount of alcohol consumption per week were significant risk factors for incident AF, whereas the amount of alcohol consumption per each drinking session was not necessarily an independent risk factor 15 .…”

Section: Discussionmentioning

confidence: 96%

Association between clustering of unhealthy lifestyle factors and risk of new-onset atrial fibrillation: a nationwide population-based study

Lee

Choi

Ahn

et al. 2020

Sci Rep

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We aimed to investigate the association between the combination of unhealthy lifestyle and risk of AF. Subjects aged 66 years who underwent health examination from 2009 to 2015 were included. The cohort was divided into 8 groups by the combination of unhealthy lifestyle including current smoking, heavy drinking (> 30 g/day), and lack of regular exercise, and followed up for new-onset AF till December 31, 2017. Among 1,719,401 subjects, 47,334 had incident AF (5.5 per 1000 person-years) during a 5-year mean follow-up period. Lack of regular exercise was the most powerful factor to be associated with a higher risk of AF as a single factor (adjusted hazard ratio 1.11, 95% confidence interval 1.08–1.13). Amongst combinations of two unhealthy lifestyle factors, current smoking with heavy drinking, lack of regular exercise with heavy drinking, and lack of regular exercise with current smoking were associated with a 6%, 15%, and 20% higher risks of AF, respectively. A cluster of three unhealthy lifestyle components was associated with a 22% higher risk of AF. Increased numbers of unhealthy lifestyle factors were associated with a higher risk of incident AF. These findings support the promotion of a healthy lifestyle to lower the risk of new-onset AF.

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“…Sources: Kistler et al 2004,[ 38 ] Dimitri et al 2012,[ 33 ] Stiles et al 2009,[ 41 ] Mahajan et al 2018[ 30 ] and Voskoboinik et al 2019. [ 36 ] Adapted with permission from Elsevier. Medi et al 2011.…”

Section: Abnormal Atrial Substrates and Structural Remodelling In Conmentioning

confidence: 99%

“…Similar findings were recently found in Voskoboinik et al’s study of the atrial substrate among alcohol consumers. [ 36 ] The authors performed high-density electroanatomic mapping of the LA in 75 patients undergoing PVI for AF. Patients were classified as lifelong non-drinkers, mild drinkers (2–7 drinks/week) and moderate drinkers (8–21 drinks/week).…”

Section: Abnormal Atrial Substrates and Structural Remodelling In Conmentioning

confidence: 99%

Atrial Fibrillation Structural Substrates: Aetiology, Identification and Implications

Al‐Kaisey

Lee

Kalman

2020

Arrhythm Electrophysiol Rev

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AF is the most common sustained cardiac rhythm disorder and is associated with increased morbidity and mortality. Since the first description of AF initiation by triggers from pulmonary veins sleeves, pulmonary vein isolation (PVI) has become the standard ablation strategy in patients with AF. 1 However, freedom from the arrhythmia, particularly in non-paroxysmal AF, remains suboptimal, and it is now clear that, in these patients, AF is maintained by an atrial substrate beyond the pulmonary veins. Although electrical remodelling may be reversible with termination of the arrhythmia, the development of atrial substrate due to fibrosis contributes to the progression of the AF phenotype from paroxysmal to persistent AF, leading to an arrhythmia that is more refractory to intervention. 2 It is clear from animal and human studies that prolonged AF can cause this structural change. Moreover, it is also apparent that a range of risk factors associated with AF, including age, obesity, heart failure (HF), valvular heart disease, hypertension (HT), sleep apnoea and alcohol intake, may also progress atrial remodelling. The rise in the prevalence of cardiovascular risk factors (particularly driven by ageing populations and the obesity epidemic) has been associated with an increase in the prevalence of AF and AF-related hospitalisations. 3 In this review, we focus on insights from electrophysiological mapping studies in cohorts with AF risk factors. We discuss substrate mapping and its implications for AF management and outcomes, and also focus on potential pitfalls. The Second Factor: Structural Remodelling is Required for AF Maintenance Early studies of animal models have demonstrated that AF promotes acute electrical remodelling, which in turn leads to further AF, thereby introducing the seminal concept that 'AF begets AF'. 4-6 In response to either induced AF or rapid atrial pacing, a reduction in the atrial effective refractory period (ERP) occurs with an increase in the spatial heterogeneity of ERP and loss of normal ERP rate adaptation, all resulting in progressively longer durations of AF. In this model, termination of the arrhythmia results in remodelling reversal, suggesting that sinus rhythm may beget sinus rhythm. However, human studies of early intervention to re-establish sinus rhythm do not fully support this concept; the re-establishment of sinus rhythm has not been found to prevent the progression of AF in the majority of patients. 7,8 Ongoing work has indicated that, beyond acute electrical remodelling, structural remodelling also occurs and is not necessarily fully reversible. This socalled second factor has been shown to occur as a result of longer durations of AF. However, the multiple conditions associated with AF also appear to promote significant structural remodelling.

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Moderate alcohol consumption is associated with atrial electrical and structural changes: Insights from high-density left atrial electroanatomic mapping

Cited by 78 publications

References 28 publications

Lifestyle modifications for treatment of atrial fibrillation

Lifestyle modifications for treatment of atrial fibrillation

Association between clustering of unhealthy lifestyle factors and risk of new-onset atrial fibrillation: a nationwide population-based study

Atrial Fibrillation Structural Substrates: Aetiology, Identification and Implications

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