Alcohol and Afib: Getting to the Heart of the Matter

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A great deal of attention has been placed on the heart health benefits associated with drinking a moderate amount of alcohol. But for the 2.7 million people who live with a heart condition called atrial fibrillation, even moderate drinking may prove too risky.

Atrial fibrillation (afib or AF) is the most common serious heart rhythm disorder (arrhythmia). During an afib episode, the heart's two upper chambers (atria) contract quickly and irregularly. Afib can come and go or last long enough to require treatment.

People with AF are five times more likely to have a stroke, according to the American Stroke Association. In addition to stroke, afib also increases the chances of blood clots, heart failure, and other heart conditions. Risks for developing afib include high blood pressure, underlying heart disease, stress, fatigue, and alcohol.

Alcohol and Afib: What's the Real Deal?

The phenomena of alcohol-induced afib episodes was first described back in 1978. It was dubbed "holiday heart syndrome" because reports of irregular heartbeats tended to peak after holiday celebrations that involved excessive alcohol intake or binge drinking. These episodes typically resolved on their own without treatment once the person stopped drinking.

Exactly how alcohol increases risk for irregular heartbeats is not fully understood. What's more, there is also no consensus on how much, if any, alcohol can be safely imbibed among those at risk for AF or an AF episode.

Here's what we do know: People with afib are four and a half times more likely to have an episode when consuming alcohol than if they were to abstain. While several studies have shown that binge drinking can trigger an AF episode, recent research suggests that even moderate amounts of wine and liquor (but not beer) may cause the heart to skip a beat. In this study, moderate drinking was defined as one to three drinks per day. In general, moderate alcohol consumption refers to one to two drinks per day for men and one drink per day for women. Importantly, a drink is a 12 oz. beer, 4 oz. of wine, 1.5 oz. of 80-proof spirits, or 1 oz. of 100-proof spirits. This can be markedly different than the amount of alcohol in pours at bars, restaurants, or even in your own home.

The risk of AF increases with the number of alcoholic beverages consumed. The bottom line is that drinking any amount of alcohol increases afib risk when compared with drinking less than one alcoholic beverage a week. Some people may experience a quivering heart after only one drink, and others may need to consume a lot more, and researchers don't know why.

Better Safe Than Sorry

Until they can determine who is most at risk for an afib episode when consuming alcohol, abstaining is likely the way to go for people with or at risk for afib. This was the principal finding of a review of 14 published studies on the issue.

Abstinence is especially wise counsel for people with afib who take drugs to reduce their stroke risk. Such blood-thinning or clot-busting drugs including warfarin (Coumadin) don't mix with alcohol. Drinking alcohol while taking these medications can increase risk of bleeding. If you have afib, discuss your personal risk profile with your doctor to determine how much alcohol is too much for you.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2018 Dec 4

  1. Larsson SC, et al. A Prospective Study and Dose-Response Meta-Analysis. J Am Coll Cardiol. 2014;64(3):281-89. doi:10.1016/j.jacc.2014.03.048.

  2. Kodama S, et al. Alcohol Consumption and Risk of Atrial Fibrillation: A Meta Analysis. J Am Coll Cardiol. 2011;57(4):427-36. doi:10.1016/j.jacc.2010.08.641

  3. Mandyam MC, et al. Alcohol and Vagal Tone as Triggers for Paroxysmal Atrial Fibrillation. Am J Cardiol. 2012;171(17):1571-8.

  4. What is AF? American Heart Association.

  5. Alcohol and Heart Health. American Heart Association.

  6. Atrial Fibrillation. American Stroke Association.

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