ETOH-AF
https://www.nejm.org/doi/full/10.1056/NEJMoa1817591
ETOH-AF
Clinical Question
In patients with regular alcohol consumption and prior symptomatic atrial fibrillation, does abstinence from alcohol reduce risk of recurrent atrial fibrillation?
Bottom Line
For patients with regular alcohol consumption and prior symptomatic atrial fibrillation, abstinence from alcohol compared to baseline alcohol consumption decreased the primary endpoints of recurrent atrial fibrillation and atrial fibrillation burden.
Major Points
Alcohol consumption has been identified as a risk factor for atrial fibrillation, but the benefit of abstinence on rate of recurrent atrial fibrillation remains unclear.
Guidelines
No guidelines reflect the results of this trial as of January 2020.
Design
- Randomized, open-label, prospective, multicenter trial
- N=146
- Abstinence from alcohol consumption (n=70)
- Baseline alcohol consumption (n=70)
- Setting: 6 centers in Australia
- Enrollment: March 2016 to February 2018
- Follow-up: Median 6 months (interquartile range, 6 months to 6 months)
- Analysis: Intention-to-treat
- Primary end points:
- Recurrent atrial fibrillation >30 seconds in duration
- Median percentage of time in atrial fibrillation
Population
Inclusion Criteria
- 18-85 years old
- Symptomatic paroxysmal atrial fibrillation with greater than or equal to 2 episodes in the prior 6 months or symptomatic persistent atrial fibrillation on a rhythm-control strategy
- Regular alcohol consumption of 10 or more standard drinks (120 g of alcohol) per week
Exclusion Criteria
- Alcohol dependence or abuse
- Left ventricular ejection fraction less than 35%
- Clinically significant non-cardiac disease
- Concomitant psychiatric disorder
Baseline Characteristics
From the alcohol abstinence group.
- Mean age: 61.69.4 years
- Male sex: 87%
- Weight: 89.716.0 kg
- BMI: 28.44.4
- Hypertension: 44%
- Diabetes mellitus: 7%
- Dyslipidemia: 16%
- Previous TIA or stroke: 10%
- Previous or current smoker: 19%
- OSA: 17%
- Previous heart failure: 9%
- CHA2DS2-VASc: 1.51.2
- Paroxysmal atrial fibrillation: 64%
- Persistent atrial fibrillation: 36%
- Previous atrial fibrillation ablation: 29%
- Pacemaker or loop recorder: 36%
- Antiarrhythmic therapy: 63%
- Amiodarone: 9%
- Sotalol: 29%
- Flecainide: 26%
- Alcohol intake: 16.87.7 standard drinks/week
- Beverages consumed
- Wine: 69%
- Beer: 49%
- Spirits: 19%
- Binge drinking: 29%
Interventions
- Randomized to abstinence from alcohol use or continued baseline alcohol use
Outcomes
Comparisons are abstinence from alcohol use vs. continued baseline alcohol use.
Primary Outcome
- Recurrent atrial fibrillation >30 seconds in duration
- 53% vs. 73% (HR 0.55; 95% CI 0.36 to 0.84; p=0.005)
- Median percentage of time in atrial fibrillation
- 0.5% (IQR 0..0 to 3.0) vs. 1.2% (IQR 0.0 to 10.3) (p=0.01)
Secondary Outcomes
Subgroup Analysis
Adverse Events
No adverse events other than the outcomes listed above were reported.
Criticisms
It is unclear if the results would apply to patients with higher burdens of atrial fibrillation.
Funding
Further Reading
https://www.nejm.org/doi/full/10.1056/NEJMoa1817591 https://www.nejm.org/doi/full/10.1056/NEJMe1914981