Alcohol and Atrial Fibrillation: An Update and New Perspectives

In the Western world, sales of alcoholic beverages are skyrocketing. Alcohol (ethanol) is consumed for its transient euphoric effects but is a risk factor for the development of heart disease. Here, we review the possible association between alcohol consumption and atrial fibrillation. Using a familiar analogy, we propose that atrial fibrillation is the mere tip of an iceberg (alcohol-associated heart disease). Our concern is that the many research studies on the effects of ethanol on the heart have produced inconsistent results. These include studies of individuals drinking only moderate amounts of alcoholic beverages (aka the "French paradox") on the one hand, and paroxysmal atrial fibrillation after binge drinking ("holiday heart syndrome") on the other hand. The evidence available in the literature suggests that hypertension, structured heart disease of any form, neurohumoral stress, and cardiometabolic disorders all favor the development of atrial fibrillation triggered by alcohol. We also suggest that alcohol should be classified as a modifiable risk factor for atrial fibrillation, and also for heart disease in general.