AFFAIR - Alcohol as a Modifiable Risk Factor for Atrial Fibrillation

Background

Atrial fibrillation Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, and the lifetime risk of de-veloping AF is approximately one out of three. It has a prevalence of approximately 50 million peo-ple worldwide which is expected to increase which entails significant health care costs. AF symp-toms include palpitations, shortness of breath, and fatigue. The condition may lead to discomfort from symptoms and medical treatment, reduced quality of life, and an increased risk of heart fail-ure, stroke, and death. The medical treatment of AF consists of rhythm and rate control together with anticoagulants. Ablation treatment is an effective way to prevent AF episodes, reduce symp-toms and improve quality of life. Sinus rhythm is restored by destroying the electrical impulses that cause the arrhythmia. The cornerstone of the treatment is isolation of the pulmonary veins, where the AF typically originates in otherwise healthy individuals. The electrical impulses can be treated via invasive catheters that reach the heart through the veins in the groin. The long-term success rate varies from 50-80 %. Typically, AF progresses over time from paroxysmal to persistent to per-manent due to structural remodeling of the atrium, described in the literature as 'AF begets AF'. Risk factors for the development of AF include age, male gender, ischemic heart disease, hyperten-sion, and heart failure. In Denmark, the number of ablation treatments is increasing primarily be-cause of an increasing number of AF patients. Modifiable risk factors such as obesity, physical inac-tivity, smoking, and alcohol consumption, have gained more attention in preventing AF and improv-ing the outcome of the treatment of AF. The phenomenon 'holiday heart syndrome' was first de-scribed by Ettinger et al in 1978. It is an alcohol-induced arrhythmia in a person without other clinical evidence of heart disease. Several studies have since then shown a dose-response dependent relationship between alcohol consumption and the development of AF, and even alcohol in small doses is reported to be a common trigger for AF episodes. A recent study involving 140 patients showed that it is possible to reduce the burden of AF by abstaining from alcohol. Alcohol's effect on the recurrence of AF is not yet fully understood but is probably related to an increased number of low-voltage zones in the heart. Evidence about improving the outcome of AF ablation by reduc-ing alcohol intake is scarce and more robust studies are needed to investigate how modifiable risk factors, like alcohol, affect the success rate of ablation treatment. Therefore, this study aims to investigate how alcohol abstinence affects the outcome of atrial fibrillation ablation treatment.

Methods

Design The study is designed as an open-label, pragmatic, prospective, 1:1 Randomized Controlled Trial (RCT) that will be preceded by a feasibility study that will test the feasibility of the proposed intervention for the RCT study. The intervention will be led by health professionals and will focus on alcohol abstinence.

After evaluating the outcomes of the feasibility study any appropriate adjustments will be made.