Alcohol intake is significantly associated with atrial flutter in patients under 60 years of age and a shorter right atrial effective refractory period.
BACKGROUND
Although evidence suggests that alcohol is associated with atrial fibrillation (AF), the association between alcohol and atrial flutter (AFL) has not been examined. The mechanism connecting alcohol and atrial arrhythmias is unknown.


METHODS
Alcohol intake was determined in 195 consecutive patients with AF and AFL. Control subjects included patients with other supraventricular arrhythmias (n = 132) and healthy subjects (n = 54). Because of important competing risk factors for atrial arrhythmias in the elderly, stratification by age was performed. In a subset, atrial effective refractory periods (AERPs) were obtained from the high right atrium and proximal and distal coronary sinus.


RESULTS
AF and AFL patients were significantly more likely to be daily alcohol drinkers (27% vs 14% of controls, P = 0.001). In multivariable analysis, AFL patients < or = 60 years of age were significantly more likely to be daily drinkers than to drink no alcohol compared to controls (odds ratio 17, 95% confidence interval 1.6-192.0, P = 0.019). Progressively more frequent alcohol intake was significantly associated with a progressively greater odds of AFL in patients < or = 60 years of age (P = 0.045). Neither AF subjects of any age nor AFL subjects > 60 years of age exhibited significant associations with alcohol after multivariable adjustment. Right AERPs shortened significantly with increasing amounts of alcohol intake (P = 0.025), whereas left AERPs were not associated with alcohol intake.


CONCLUSIONS
Alcohol intake is positively associated with AFL in younger patients. The mechanism may be related to a shortening of the right AERP.
Marcus
Gregory M
GM
Division of Cardiology, Electrophysiology Section, University of California, San Francisco, San Francisco, California, USA. marcusg@medicine.ucsf.edu
Smith
Lisa M
LM
Whiteman
Dean
D
Tseng
Zian H
ZH
Badhwar
Nitish
N
Lee
Byron K
BK
Lee
Randall J
RJ
Scheinman
Melvin M
MM
Olgin
Jeffrey E
JE
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000428:Alcohol Drinking / Q000453:epidemiology* / Q000503:physiopathology*; D001282:Atrial Flutter / Q000453:epidemiology* / Q000503:physiopathology*; D002140:California / Q000453:epidemiology; D016022:Case-Control Studies; D015897:Comorbidity; D004562:Electrocardiography / Q000706:statistics & numerical data; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013223:Statistics as Topic