Acute Consumption of Alcohol and Discrete Atrial Fibrillation Events

Ann Intern Med. 2021 Nov;174(11):1503-1509. doi: 10.7326/M21-0228. Epub 2021 Aug 31.


Background: Patients' self-reports suggest that acute alcohol consumption may trigger a discrete atrial fibrillation (AF) event.

Objective: To objectively ascertain whether alcohol consumption heightens risk for an AF episode.

Design: A prospective, case-crossover analysis.

Setting: Ambulatory persons in their natural environments.

Participants: Consenting patients with paroxysmal AF.

Measurements: Participants were fitted with a continuous electrocardiogram (ECG) monitor and an ankle-worn transdermal ethanol sensor for 4 weeks. Real-time documentation of each alcoholic drink consumed was self-recorded using a button on the ECG recording device. Fingerstick blood tests for phosphatidylethanol (PEth) were used to corroborate ascertainments of drinking events.

Results: Of 100 participants (mean age, 64 years [SD, 15]; 79% male; 85% White), 56 had at least 1 episode of AF. Results of PEth testing correlated with the number of real-time recorded drinks and with events detected by the transdermal alcohol sensor. An AF episode was associated with 2-fold higher odds of 1 alcoholic drink (odds ratio [OR], 2.02 [95% CI, 1.38 to 3.17]) and greater than 3-fold higher odds of at least 2 drinks (OR, 3.58 [CI, 1.63 to 7.89]) in the preceding 4 hours. Episodes of AF were also associated with higher odds of peak blood alcohol concentration (OR, 1.38 [CI, 1.04 to 1.83] per 0.1% increase in blood alcohol concentration) and the total area under the curve of alcohol exposure (OR, 1.14 [CI, 1.06 to 1.22] per 4.7% increase in alcohol exposure) inferred from the transdermal ethanol sensor in the preceding 12 hours.

Limitation: Confounding by other time-varying exposures that may accompany alcohol consumption cannot be excluded, and the findings from the current study of patients with AF consuming alcohol may not apply to the general population.

Conclusion: Individual AF episodes were associated with higher odds of recent alcohol consumption, providing objective evidence that a modifiable behavior may influence the probability that a discrete AF event will occur.

Primary funding source: National Institute on Alcohol Abuse and Alcoholism.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Alcohol Drinking / adverse effects*
  • Atrial Fibrillation / etiology*
  • Blood Alcohol Content
  • Cross-Over Studies
  • Electrocardiography, Ambulatory
  • Female
  • Humans
  • Male
  • Middle Aged
  • Prospective Studies


  • Blood Alcohol Content