Article Text

Download PDFPDF
General medicine
Alcohol and atrial fibrillation: to or not to drink?
  1. Jack W O'Sullivan1,2
  1. 1 Division of Cardiology, Department of Medicine, Stanford University, Stanford, California, USA
  2. 2 Centre for Evidence-Based Medicine, University of Oxford, Oxford, UK
  1. Correspondence to Dr Jack W O'Sullivan, Stanford University, Stanford, CA 94305, USA; jackos{at}

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

EBM Verdict

EBM Verdict on: Voskoboinik A, Kalman MJ, Silva DA, et al. Alcohol Abstinence in Drinkers with Atrial Fibrillation. N Engl J Med 2020; 382:20–28. DOI: 10.1056/NEJMoa1817591

  • In patients with (AF who are regular drinkers of 10 or more standard rinks a week) an alcohol abstinence programme leads to 20% (95% CI 4.3% to 36%) less exacerbations of AF: number needed to treat 5 (95% CI 3 to 28).

Alcohol has long been considered a risk factor for atrial fibrillation (AF). However, it has been uncertain whether reducing alcohol consumption reduces the risk of AF exacerbations as there has been no evidence from randomised controlled trials until now.

In 1978, the term ‘Holiday heart’ was coined—referring to exacerbations of atrial fibrillation (AF) associated with excessive drinking (typically around the holiday season).1 Since then, many observational studies have shown the seemingly dose-dependent relationship between alcohol intake and incident AF.2 Despite this accumulating observational evidence, the effect …

View Full Text


  • Twitter @DrJackOSullivan

  • Contributors JO is sole author.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.