Alcohol abstinence in drinkers with atrial fibrillation

Aleksandr Voskoboinik; Jonathan M. Kalman; Anurika De Silva; Thomas Nicholls; Benedict Costello; Shane Nanayakkara; Sandeep Prabhu; Dion Stub; Sonia Azzopardi; Donna Vizi; Geoffrey Wong; Chrishan Nalliah; Hariharan Sugumar; Michael Wong; Emily Kotschet; David Kaye; Andrew J. Taylor; Peter M. Kistler

doi:10.1056/NEJMoa1817591

Alcohol abstinence in drinkers with atrial fibrillation

Aleksandr Voskoboinik, Jonathan M. Kalman, Anurika De Silva, Thomas Nicholls, Benedict Costello, Shane Nanayakkara, Sandeep Prabhu, Dion Stub, Sonia Azzopardi, Donna Vizi, Geoffrey Wong, Chrishan Nalliah, Hariharan Sugumar, Michael Wong, Emily Kotschet, David Kaye, Andrew J. Taylor, Peter M. Kistler

Research output: Contribution to journal › Article › peer-review

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Abstract

BACKGROUND: Excessive alcohol consumption is associated with incident atrial fibrillation and adverse atrial remodeling; however, the effect of abstinence from alcohol on secondary prevention of atrial fibrillation is unclear.

METHODS: We conducted a multicenter, prospective, open-label, randomized, controlled trial at six hospitals in Australia. Adults who consumed 10 or more standard drinks (with 1 standard drink containing approximately 12 g of pure alcohol) per week and who had paroxysmal or persistent atrial fibrillation in sinus rhythm at baseline were randomly assigned in a 1:1 ratio to either abstain from alcohol or continue their usual alcohol consumption. The two primary end points were freedom from recurrence of atrial fibrillation (after a 2-week "blanking period") and total atrial fibrillation burden (proportion of time in atrial fibrillation) during 6 months of follow-up.

RESULTS: Of 140 patients who underwent randomization (85% men; mean [±SD] age, 62±9 years), 70 were assigned to the abstinence group and 70 to the control group. Patients in the abstinence group reduced their alcohol intake from 16.8±7.7 to 2.1±3.7 standard drinks per week (a reduction of 87.5%), and patients in the control group reduced their alcohol intake from 16.4±6.9 to 13.2±6.5 drinks per week (a reduction of 19.5%). After a 2-week blanking period, atrial fibrillation recurred in 37 of 70 patients (53%) in the abstinence group and in 51 of 70 patients (73%) in the control group. The abstinence group had a longer period before recurrence of atrial fibrillation than the control group (hazard ratio, 0.55; 95% confidence interval, 0.36 to 0.84; P = 0.005). The atrial fibrillation burden over 6 months of follow-up was significantly lower in the abstinence group than in the control group (median percentage of time in atrial fibrillation, 0.5% [interquartile range, 0.0 to 3.0] vs. 1.2% [interquartile range, 0.0 to 10.3]; P = 0.01).

CONCLUSIONS: Abstinence from alcohol reduced arrhythmia recurrences in regular drinkers with atrial fibrillation. (Funded by the Government of Victoria Operational Infrastructure Support Program and others; Australian New Zealand Clinical Trials Registry number, ACTRN12616000256471.).

Original language	English
Pages (from-to)	20-28
Number of pages	9
Journal	New England Journal of Medicine
Volume	382
Issue number	1
DOIs	https://doi.org/10.1056/NEJMoa1817591
Publication status	Published - 2 Jan 2020
Externally published	Yes

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Voskoboinik, A., Kalman, J. M., De Silva, A., Nicholls, T., Costello, B., Nanayakkara, S., Prabhu, S., Stub, D., Azzopardi, S., Vizi, D., Wong, G., Nalliah, C., Sugumar, H., Wong, M., Kotschet, E., Kaye, D., Taylor, A. J., & Kistler, P. M. (2020). Alcohol abstinence in drinkers with atrial fibrillation. New England Journal of Medicine, 382(1), 20-28. https://doi.org/10.1056/NEJMoa1817591

Voskoboinik, Aleksandr ; Kalman, Jonathan M. ; De Silva, Anurika ; Nicholls, Thomas ; Costello, Benedict ; Nanayakkara, Shane ; Prabhu, Sandeep ; Stub, Dion ; Azzopardi, Sonia ; Vizi, Donna ; Wong, Geoffrey ; Nalliah, Chrishan ; Sugumar, Hariharan ; Wong, Michael ; Kotschet, Emily ; Kaye, David ; Taylor, Andrew J. ; Kistler, Peter M. / Alcohol abstinence in drinkers with atrial fibrillation. In: New England Journal of Medicine. 2020 ; Vol. 382, No. 1. pp. 20-28.

@article{3c7d84119bbe47a78deceb71daadb0ab,

title = "Alcohol abstinence in drinkers with atrial fibrillation",

abstract = "BACKGROUND: Excessive alcohol consumption is associated with incident atrial fibrillation and adverse atrial remodeling; however, the effect of abstinence from alcohol on secondary prevention of atrial fibrillation is unclear.METHODS: We conducted a multicenter, prospective, open-label, randomized, controlled trial at six hospitals in Australia. Adults who consumed 10 or more standard drinks (with 1 standard drink containing approximately 12 g of pure alcohol) per week and who had paroxysmal or persistent atrial fibrillation in sinus rhythm at baseline were randomly assigned in a 1:1 ratio to either abstain from alcohol or continue their usual alcohol consumption. The two primary end points were freedom from recurrence of atrial fibrillation (after a 2-week {"}blanking period{"}) and total atrial fibrillation burden (proportion of time in atrial fibrillation) during 6 months of follow-up.RESULTS: Of 140 patients who underwent randomization (85% men; mean [±SD] age, 62±9 years), 70 were assigned to the abstinence group and 70 to the control group. Patients in the abstinence group reduced their alcohol intake from 16.8±7.7 to 2.1±3.7 standard drinks per week (a reduction of 87.5%), and patients in the control group reduced their alcohol intake from 16.4±6.9 to 13.2±6.5 drinks per week (a reduction of 19.5%). After a 2-week blanking period, atrial fibrillation recurred in 37 of 70 patients (53%) in the abstinence group and in 51 of 70 patients (73%) in the control group. The abstinence group had a longer period before recurrence of atrial fibrillation than the control group (hazard ratio, 0.55; 95% confidence interval, 0.36 to 0.84; P = 0.005). The atrial fibrillation burden over 6 months of follow-up was significantly lower in the abstinence group than in the control group (median percentage of time in atrial fibrillation, 0.5% [interquartile range, 0.0 to 3.0] vs. 1.2% [interquartile range, 0.0 to 10.3]; P = 0.01).CONCLUSIONS: Abstinence from alcohol reduced arrhythmia recurrences in regular drinkers with atrial fibrillation. (Funded by the Government of Victoria Operational Infrastructure Support Program and others; Australian New Zealand Clinical Trials Registry number, ACTRN12616000256471.).",

author = "Aleksandr Voskoboinik and Kalman, {Jonathan M.} and {De Silva}, Anurika and Thomas Nicholls and Benedict Costello and Shane Nanayakkara and Sandeep Prabhu and Dion Stub and Sonia Azzopardi and Donna Vizi and Geoffrey Wong and Chrishan Nalliah and Hariharan Sugumar and Michael Wong and Emily Kotschet and David Kaye and Taylor, {Andrew J.} and Kistler, {Peter M.}",

note = "Copyright {\textcopyright} 2020 Massachusetts Medical Society.",

year = "2020",

month = jan,

day = "2",

doi = "10.1056/NEJMoa1817591",

language = "English",

volume = "382",

pages = "20--28",

journal = "New England Journal of Medicine",

issn = "0028-4793",

publisher = "Massachussetts Medical Society",

number = "1",

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Voskoboinik, A, Kalman, JM, De Silva, A, Nicholls, T, Costello, B, Nanayakkara, S, Prabhu, S, Stub, D, Azzopardi, S, Vizi, D, Wong, G, Nalliah, C, Sugumar, H, Wong, M, Kotschet, E, Kaye, D, Taylor, AJ & Kistler, PM 2020, 'Alcohol abstinence in drinkers with atrial fibrillation', New England Journal of Medicine, vol. 382, no. 1, pp. 20-28. https://doi.org/10.1056/NEJMoa1817591

Alcohol abstinence in drinkers with atrial fibrillation. / Voskoboinik, Aleksandr; Kalman, Jonathan M.; De Silva, Anurika; Nicholls, Thomas; Costello, Benedict; Nanayakkara, Shane; Prabhu, Sandeep; Stub, Dion; Azzopardi, Sonia; Vizi, Donna; Wong, Geoffrey; Nalliah, Chrishan; Sugumar, Hariharan; Wong, Michael; Kotschet, Emily; Kaye, David; Taylor, Andrew J.; Kistler, Peter M.

In: New England Journal of Medicine, Vol. 382, No. 1, 02.01.2020, p. 20-28.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Alcohol abstinence in drinkers with atrial fibrillation

AU - Voskoboinik, Aleksandr

AU - Kalman, Jonathan M.

AU - De Silva, Anurika

AU - Nicholls, Thomas

AU - Costello, Benedict

AU - Nanayakkara, Shane

AU - Prabhu, Sandeep

AU - Stub, Dion

AU - Azzopardi, Sonia

AU - Vizi, Donna

AU - Wong, Geoffrey

AU - Nalliah, Chrishan

AU - Sugumar, Hariharan

AU - Wong, Michael

AU - Kotschet, Emily

AU - Kaye, David

AU - Taylor, Andrew J.

AU - Kistler, Peter M.

PY - 2020/1/2

Y1 - 2020/1/2

N2 - BACKGROUND: Excessive alcohol consumption is associated with incident atrial fibrillation and adverse atrial remodeling; however, the effect of abstinence from alcohol on secondary prevention of atrial fibrillation is unclear.METHODS: We conducted a multicenter, prospective, open-label, randomized, controlled trial at six hospitals in Australia. Adults who consumed 10 or more standard drinks (with 1 standard drink containing approximately 12 g of pure alcohol) per week and who had paroxysmal or persistent atrial fibrillation in sinus rhythm at baseline were randomly assigned in a 1:1 ratio to either abstain from alcohol or continue their usual alcohol consumption. The two primary end points were freedom from recurrence of atrial fibrillation (after a 2-week "blanking period") and total atrial fibrillation burden (proportion of time in atrial fibrillation) during 6 months of follow-up.RESULTS: Of 140 patients who underwent randomization (85% men; mean [±SD] age, 62±9 years), 70 were assigned to the abstinence group and 70 to the control group. Patients in the abstinence group reduced their alcohol intake from 16.8±7.7 to 2.1±3.7 standard drinks per week (a reduction of 87.5%), and patients in the control group reduced their alcohol intake from 16.4±6.9 to 13.2±6.5 drinks per week (a reduction of 19.5%). After a 2-week blanking period, atrial fibrillation recurred in 37 of 70 patients (53%) in the abstinence group and in 51 of 70 patients (73%) in the control group. The abstinence group had a longer period before recurrence of atrial fibrillation than the control group (hazard ratio, 0.55; 95% confidence interval, 0.36 to 0.84; P = 0.005). The atrial fibrillation burden over 6 months of follow-up was significantly lower in the abstinence group than in the control group (median percentage of time in atrial fibrillation, 0.5% [interquartile range, 0.0 to 3.0] vs. 1.2% [interquartile range, 0.0 to 10.3]; P = 0.01).CONCLUSIONS: Abstinence from alcohol reduced arrhythmia recurrences in regular drinkers with atrial fibrillation. (Funded by the Government of Victoria Operational Infrastructure Support Program and others; Australian New Zealand Clinical Trials Registry number, ACTRN12616000256471.).

AB - BACKGROUND: Excessive alcohol consumption is associated with incident atrial fibrillation and adverse atrial remodeling; however, the effect of abstinence from alcohol on secondary prevention of atrial fibrillation is unclear.METHODS: We conducted a multicenter, prospective, open-label, randomized, controlled trial at six hospitals in Australia. Adults who consumed 10 or more standard drinks (with 1 standard drink containing approximately 12 g of pure alcohol) per week and who had paroxysmal or persistent atrial fibrillation in sinus rhythm at baseline were randomly assigned in a 1:1 ratio to either abstain from alcohol or continue their usual alcohol consumption. The two primary end points were freedom from recurrence of atrial fibrillation (after a 2-week "blanking period") and total atrial fibrillation burden (proportion of time in atrial fibrillation) during 6 months of follow-up.RESULTS: Of 140 patients who underwent randomization (85% men; mean [±SD] age, 62±9 years), 70 were assigned to the abstinence group and 70 to the control group. Patients in the abstinence group reduced their alcohol intake from 16.8±7.7 to 2.1±3.7 standard drinks per week (a reduction of 87.5%), and patients in the control group reduced their alcohol intake from 16.4±6.9 to 13.2±6.5 drinks per week (a reduction of 19.5%). After a 2-week blanking period, atrial fibrillation recurred in 37 of 70 patients (53%) in the abstinence group and in 51 of 70 patients (73%) in the control group. The abstinence group had a longer period before recurrence of atrial fibrillation than the control group (hazard ratio, 0.55; 95% confidence interval, 0.36 to 0.84; P = 0.005). The atrial fibrillation burden over 6 months of follow-up was significantly lower in the abstinence group than in the control group (median percentage of time in atrial fibrillation, 0.5% [interquartile range, 0.0 to 3.0] vs. 1.2% [interquartile range, 0.0 to 10.3]; P = 0.01).CONCLUSIONS: Abstinence from alcohol reduced arrhythmia recurrences in regular drinkers with atrial fibrillation. (Funded by the Government of Victoria Operational Infrastructure Support Program and others; Australian New Zealand Clinical Trials Registry number, ACTRN12616000256471.).

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U2 - 10.1056/NEJMoa1817591

DO - 10.1056/NEJMoa1817591

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VL - 382

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JO - New England Journal of Medicine

JF - New England Journal of Medicine

SN - 0028-4793

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Alcohol abstinence in drinkers with atrial fibrillation

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