Should I stop drinking if I have been diagnosed with atrial fibrillation? – .

Should I stop drinking if I have been diagnosed with atrial fibrillation? – .

The question: I was diagnosed with a heart rhythm problem called atrial fibrillation. My doctor says alcohol makes it worse. Should I stop drinking?

The answer: Doctors have long known that excessive alcohol consumption can trigger episodes of atrial fibrillation, or A-fib. Too much alcohol over a very short period of time disrupts heart function, even in relatively healthy people.

The medical profession has dubbed the condition “vacation heart syndrome” because binge drinking tends to occur on weekends and holidays.

However, a growing body of research suggests that even moderate drinking – as little as a glass of wine or a bottle of beer – can trigger A-fib in people susceptible to heart rhythm disturbances.

To better understand the risk, it’s worth looking at what actually happens during atrial fibrillation.

Normally, the different chambers of the heart work in a coordinated and systematic way to distribute oxygenated blood throughout the body. The heart’s electrical system controls contractions.

But in the case of A-fib, the upper chambers of the heart (atria), which are responsible for pushing blood into the two lower chambers (ventricles), contract quickly and chaotically.

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Essentially, the heart’s electrical system is malfunctioning. “You receive pulses from all areas of the upper chamber of your heart,” says Tara O’Brien, general internist at Women’s College Hospital in Toronto. “So varying amounts of blood are pushed to the lower chambers. “

People experience these irregular heartbeats in a variety of ways. They may experience chest discomfort, heart palpitations, shortness of breath, and may even pass out. And yet, some of these individuals do not notice anything abnormal, except occasional bouts of fatigue.

Initially, episodes can last a few minutes or several hours. Over time, however, they often progress to persistent atrial fibrillation, in which the abnormal rhythm continues for prolonged periods of time and can become permanent, says Dr. O’Brien.

Left untreated, A-fib can have catastrophic consequences. Chaotic contractions can cause blood to stagnate or pool in the chambers of the heart. This, in turn, can lead to the formation of blood clots, which can then travel to the brain and cause a stroke. In fact, about a quarter of strokes in people over 50 are related to A-fib.

It can also lead to heart failure, where this vital organ is unable to supply the body with sufficient amounts of oxygenated blood.

The risk of developing A-fib increases with age. About 2% of people under 65 have A-fib, while 9% of people over 65 have it. And, in the over 80 age group, the prevalence jumps to 15 percent, says Dr. O’Brien.

Many medical conditions can disrupt the heart’s normal electrical activity and lead to A-fib, including high blood pressure, diabetes, sleep apnea, and obesity.

Those who already have the condition are extremely sensitive to the effects of alcohol. “It makes heart muscle cells more excitable and more likely to contract from any trigger,” says Eugene Crystal, cardiologist at Sunnybrook Health Sciences Center in Toronto.

An American study published in August in the Annals of Internal Medicine found that an alcoholic drink doubled an A-fib patient’s chance of having an episode within hours.

Atrial fibrillation is treated with various drugs that help normalize the heartbeat. In addition, blood thinners or blood thinners are often prescribed to reduce the risk of stroke.

Some patients may require invasive medical procedures such as ablation, in which failed electrical cells are destroyed.

Dr Crystal points out that these treatments will be less effective in patients who continue to drink alcohol regularly.

And, for this reason, a growing number of physicians are urging their A-fib patients to avoid alcohol altogether.

“I used to tell them to cut back on their alcohol consumption. Now I recommend abstinence, ”says Dr. O’Brien.

She changed her mind after a landmark Australian study published in the New England Journal of Medicine in January 2020.

This randomized controlled trial clearly demonstrated the benefits of eliminating alcohol whenever possible. “Drinkers spent more than twice as much time with atrial fibrillation as non-drinkers,” says Dr. O’Brien.

Doctors readily concede that many patients do not appreciate the news they need to stop drinking alcohol. “It’s a tough choice for some people,” says Dr. Crystal. Despite this, he urges patients to “try abstinence and see if it improves your A-fib.”

If it’s too hard to give up all alcohol, then at least cut it down. “The bottom line is, less is better,” says Dr. O’Brien.

There is a popular belief – or perhaps a misconception – that drinking is good for the heart. But when it comes to atrial fibrillation, especially for people with a history of the disease, nothing could be further from the truth.

Paul Taylor is a former Patient Navigation Advisor at Sunnybrook Health Sciences Center and former Editor-in-Chief of The Globe and Mail.

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