Moderate alcohol consumption is associated with atrial electrical and structural changes: Insights from high-density left atrial electroanatomic mapping
Original article
Summary
Excessive alcohol use is an established risk factor for atrial fibrillation (AF), but what are the effects of moderate and mild use on AF?
Researchers showed that regular low-dose alcohol use results in more electrical evidence of scarring and impairments in electrical signaling compared with non-alcohol users and light alcohol users.
AF is an abnormal heart rhythm characterized by rapid and irregular beating of the atria (the two upper chambers of the heart). Observational studies suggest that even moderate regular alcohol consumption may increase the risk of AF.
A meta-analysis of seven studies involving nearly 860,000 patients and approximately 12,500 individuals with AF demonstrated an 8% increase in incident AF for each additional daily standard alcoholic beverage.
Abstract
Background
Regular alcohol intake is an important modifiable risk factor associated with atrial fibrillation (AF) and left atrial (LA) dilation.
Objective
The purpose of this study was to determine the impact of different degrees of alcohol consumption on atrial remodeling using high-density electroanatomic mapping.
Methods
The researchers enrolled 75 patients before AF ablation to undergo high-density LA mapping using a multipolar catheter. The Confidense algorithm was used to create maps during distal coronary sinus pacing at 600 ms. Bipolar voltage and complex atrial activity were assessed, and isochronal activation maps were created to determine global conduction velocity (CV). Patients were classified as lifelong non-alcohol users, mild alcohol users (2–7 drinks/week), or moderate alcohol users (8–21 drinks/week).
Results
High-density electroanatomic mapping was performed on 25 lifelong non-alcohol users, 25 mild alcohol users, and 25 low-dose alcohol users. Moderate alcohol users had significantly lower mean global bipolar voltages, slower CV, and a higher proportion of complex atrial potentials compared to non-alcohol users. Global voltage and CV did not differ significantly in mild alcohol users, but there was a significant increase in global complex potentials and regional low-voltage zones in the septum and lateral wall compared with non-alcohol users.
Conclusion
Regular low-dose alcohol consumption, but not mild consumption, is an important modifiable risk factor for AF associated with lower atrial voltage and conduction slowing. These electrical and structural changes may explain the propensity to AF in regular alcohol users.