“Your Health Checkup” is our online column by Dr. Douglas Zipes, an internationally acclaimed cardiologist, professor, author, inventor, and authority on pacing and electrophysiology. Dr. Zipes is also a contributor to The Saturday Evening Post print magazine. Subscribe to receive thoughtful articles, new fiction, health and wellness advice, and gems from our archive.
I’ve written about atrial fibrillation (AF) multiple times because of its importance as the most common sustained fast heartbeat, which affects about 33 million people worldwide and more than 5 million in the U.S. The incidence is expected to double by 2030, particularly as the population ages, leading to more than 12 million Americans having AF.
It’s also a personal issue since I have had bouts of AF.
One of the most feared complications from AF is a stroke, the risk for which may be influenced by various factors, including the anatomic shape of the heart. Blood clots coming from a portion of the top left heart chamber, the left atrial appendage, appear to be the cause. The risk of stroke varies with the shape of this tiny bit of anatomy. For example, an appendage shaped like a swan neck with a sharp curve was associated with a more than 2.5-fold risk of stroke or transient ischemic attack, while windsock morphology that had one dominant lobe was associated with a decrease in stroke risk by 68 percent. Anticoagulants reduce the stroke risk significantly and also appear to lower the risk of cognitive decline (dementia) that patients with AF can experience.
I like to drink wine, but as my GPS tells me when I’ve missed a turn, I’m recalculating, because the latest information indicates that alcohol plays a prominent role in developing AF. While discussing interactions between AF and alcohol, I recently stated that red wine in moderation is probably healthy, but I raised the issue of what constituted moderation: one or two glasses daily.
Several recent articles suggest maybe none is preferable.
One such study of 446 volunteers explored potential precipitants of AF. While participants who suffered from periodic episodes of AF reported possible triggers such as caffeine intake, exercise, and lack of sleep, the authors concluded from a composite of individualized trials that only exposure to alcohol was associated with significantly heightened risks of AF events, i.e., alcohol was the only consistent trigger causing AF. Reducing alcohol exposure reduced the episodes of AF.
Another report followed the drinking habits of more than 100,800 individuals and found that even modest habitual alcohol intake of 1.2 drinks/day was associated with an increased risk of AF. Frequent drinking and amount of alcohol consumption per week were found to be significant risk factors for new-onset AF, whereas the amount of alcohol consumed per each drinking session was not an independent risk factor. Avoiding the habit of consuming a low but frequent amount of alcohol might therefore be important to prevent AF.
But remember, mortality peaks occur during the Christmas and the New Year’s holidays, possibly related to overindulgence in holiday food and drink, as well as the emotional stress involved. It’s best to avoid binge drinking.
Alcohol is not the only chemical cause of AF. For example, users of methamphetamine experience an 86 percent greater risk of being diagnosed with AF, as do users of cocaine (61 percent), opiates (74 percent) and cannabis (35 percent). The likelihood of developing AF increases over time with exposure to each of the four substances, particularly in older patients.
AF can follow a surgical procedure, particularly open-heart surgery. I had my first episode of AF after surgical repair of my mitral valve over 20 years ago. A new study found that a simple surgical technique of creating a slit in the backside of the sac around the heart (pericardium) to drain excess fluid after surgery reduced post op AF by more than 50 percent. I wish my surgeon had known that years ago.
The take home message is that advances in medical science create new insights and opportunities for patients with a variety of problems, even with an ailment as old and as common as AF.
So, recalculating, I may have to give up my wine.
Featured image: Shutterstock
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