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Canadian Journal of Cardiology

Alcohol Consumption and Atrial Arrhythmia Recurrence After Atrial Fibrillation Ablation: A Systematic Review and Meta-analysis

Published:December 18, 2022DOI:https://doi.org/10.1016/j.cjca.2022.12.010

      Abstract

      Background

      Although alcohol consumption is associated with an increased risk of atrial fibrillation (AF), it is unclear whether alcohol is associated with AF recurrences after catheter ablation for AF. We aimed to systematically review the medical literature to assess the impact of alcohol consumption on the recurrence of AF after AF ablation.

      Methods

      A structured electronic database search of the scientific literature (Medline, Embase, and Central from inceptions to December 2021) was performed for studies reporting rates of AF recurrence after catheter ablation stratified by patients’ level of alcohol consumption according to study-specific definitions. Unadjusted study-specific odds ratios (ORs) were meta-analysed with the use of random-effects models. Risk of bias was evaluated by means of the ROBINS-I tool.

      Results

      We identified 9 observational studies which included 5436 patients who underwent catheter ablation for AF. Compared with patients consuming little or no alcohol, patients consuming moderate to high amounts of alcohol had a greater risk of AF recurrence (summary OR 1.45, 95% confidence interval [CI] 1.06-1.99; P = 0.02; I2 = 79%). Results remained robust when we excluded studies with < 100 participants (OR 1.40, 95% CI 1.03-1.9) or abstract-only publications (OR 1.84, 95% CI 1.21-2.8). All included studies were found to be at serious risk of bias, primarily due to confounding.

      Conclusions

      Increased alcohol consumption is associated with an increased risk of AF recurrence after catheter ablation for AF. Reduction of alcohol consumption may be beneficial in this context.

      Résumé

      Contexte

      La consommation d’alcool est associée à un risque accru de fibrillation auriculaire (FA), mais on ne sait pas si elle est aussi associée à une récurrence de la FA après son ablation par cathéter. Nous avons réalisé une revue systématique des publications médicales afin d’évaluer l’effet de la consommation d’alcool sur la récurrence de la FA après cette intervention.

      Méthodologie

      Nous avons effectué une recherche structurée dans les bases de données de publications scientifiques électroniques (Medline, Embase et Central, depuis leur création jusqu’en décembre 2021) afin de relever les études rapportant les taux de récurrence de la FA après ablation par cathéter, lesquels ont été stratifiés en fonction du degré de consommation d’alcool des patients selon la définition utilisée dans chaque étude. Les rapports de cotes (RC) non ajustés de chaque étude ont été soumis à une méta-analyse reposant sur des modèles à effets aléatoires. Le risque de biais a été évalué au moyen de l’outil ROBINS-I.

      Résultats

      Nous avons relevé 9 études observationnelles portant sur 5436 patients ayant subi une ablation par cathéter en raison d’une FA. Comparativement aux patients qui consommaient peu ou pas d’alcool, les patients qui buvaient de l’alcool en quantité modérée ou élevée présentaient un plus grand risque de récurrence de la FA (RC global : 1,45; intervalle de confiance [IC] à 95 % : 1,06 à 1,99; p = 0,02; I2 = 79 %). Les résultats sont demeurés probants même après l’exclusion des études comprenant moins de 100 participants (RC : 1,40; IC à 95 % : 1,03 à 1,9) ou des publications sous forme de résumé seulement (RC : 1,84; IC à 95 % : 1,21 à 2,8). Toutes les études retenues comportaient un risque important de biais, principalement en raison de facteurs de confusion.

      Conclusions

      Une consommation élevée d’alcool est associée à un risque accru de récurrence de la FA après ablation par cathéter. Une réduction de la consommation d’alcool pourrait donc être bénéfique dans un tel contexte.
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      Linked Article

      • Alcohol Abstinence Around Atrial Fibrillation Ablation: Breaking Common Habits
        Canadian Journal of Cardiology
        • Preview
          Alcohol consumption is an established risk factor for the development of atrial fibrillation (AF).1 Three recent meta-analyses suggest a relatively linear relationship between habitual alcohol consumption and new-onset AF, with an increasing AF risk by 8% for each extra alcoholic drink per day,2 by 8% for every 6 standard drinks/week,3 and by 17% in women consuming > 14 standard drinks/week or 25% in men consuming > 21 standard drinks/week.4 In addition, 2 recent analyses of large cohorts focused further on the effect of low alcohol consumption on AF risk.
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