From the Heart Center, Alfred Hospital (A.V., T.N., B.C., S.N., S.P., D.S., S.A., D.V., H.S., D.K., A.J.T., P.M.K.), the Baker Heart and Diabetes Institute (A.V., B.C., S.P., D.S., H.S., A.J.T., P.M.K.), the Department of Cardiology, Royal Melbourne Hospital (A.V., J.M.K., S.P., G.W., C.N., H.S.), the Department of Medicine (A.V., J.M.K., P.M.K.) and the Centre for Epidemiology and Biostatistics (A.D.S.), University of Melbourne, the Department of Cardiology, Cabrini Hospital (P.M.K.), the Department of Cardiology, Western Health (D.S., M.W.), Monash Heart, Monash Medical Centre (E.K.), and the Department of Epidemiology and Preventive Medicine (D.S.) and Medicine (A.J.T.), Monash University - all in Melbourne, VIC, Australia.
N Engl J Med. 2020 Jan 2;382(1):20-28. doi: 10.1056/NEJMoa1817591.
Excessive alcohol consumption is associated with incident atrial fibrillation and adverse atrial remodeling; however, the effect of abstinence from alcohol on secondary prevention of atrial fibrillation is unclear.
We conducted a multicenter, prospective, open-label, randomized, controlled trial at six hospitals in Australia. Adults who consumed 10 or more standard drinks (with 1 standard drink containing approximately 12 g of pure alcohol) per week and who had paroxysmal or persistent atrial fibrillation in sinus rhythm at baseline were randomly assigned in a 1:1 ratio to either abstain from alcohol or continue their usual alcohol consumption. The two primary end points were freedom from recurrence of atrial fibrillation (after a 2-week "blanking period") and total atrial fibrillation burden (proportion of time in atrial fibrillation) during 6 months of follow-up.
Of 140 patients who underwent randomization (85% men; mean [±SD] age, 62±9 years), 70 were assigned to the abstinence group and 70 to the control group. Patients in the abstinence group reduced their alcohol intake from 16.8±7.7 to 2.1±3.7 standard drinks per week (a reduction of 87.5%), and patients in the control group reduced their alcohol intake from 16.4±6.9 to 13.2±6.5 drinks per week (a reduction of 19.5%). After a 2-week blanking period, atrial fibrillation recurred in 37 of 70 patients (53%) in the abstinence group and in 51 of 70 patients (73%) in the control group. The abstinence group had a longer period before recurrence of atrial fibrillation than the control group (hazard ratio, 0.55; 95% confidence interval, 0.36 to 0.84; P = 0.005). The atrial fibrillation burden over 6 months of follow-up was significantly lower in the abstinence group than in the control group (median percentage of time in atrial fibrillation, 0.5% [interquartile range, 0.0 to 3.0] vs. 1.2% [interquartile range, 0.0 to 10.3]; P = 0.01).
Abstinence from alcohol reduced arrhythmia recurrences in regular drinkers with atrial fibrillation. (Funded by the Government of Victoria Operational Infrastructure Support Program and others; Australian New Zealand Clinical Trials Registry number, ACTRN12616000256471.).
过量饮酒与房颤事件和不良的心房重构有关；然而，戒酒对房颤的二级预防效果尚不清楚。
我们在澳大利亚的六家医院进行了一项多中心、前瞻性、开放标签、随机、对照试验。每周饮酒 10 次或以上标准饮品（1 份标准饮品含约 12 克纯酒精）且基线时窦性心律下存在阵发性或持续性房颤的成年人，按 1:1 比例随机分配至戒酒组或继续其常规饮酒组。主要终点为 2 周洗脱期后无房颤复发（无房颤期）和 6 个月随访期间总的房颤负担（房颤时间比例）。
140 名接受随机分组的患者（85%为男性；平均[±标准差]年龄 62±9 岁）中，70 名被分配至戒酒组，70 名被分配至对照组。戒酒组患者饮酒量从 16.8±7.7 标准饮品降至每周 2.1±3.7 标准饮品（减少 87.5%），对照组患者饮酒量从 16.4±6.9 标准饮品降至每周 13.2±6.5 标准饮品（减少 19.5%）。2 周洗脱期后，戒酒组 70 名患者中有 37 名（53%）和对照组 70 名患者中有 51 名（73%）复发房颤。与对照组相比，戒酒组无房颤期更长（风险比，0.55；95%置信区间，0.36 至 0.84；P=0.005）。随访 6 个月时，戒酒组的房颤负担明显低于对照组（心房颤动时间比例中位数，0.5%[四分位间距，0.0 至 3.0] vs. 1.2%[四分位间距，0.0 至 10.3%]；P=0.01）。
戒酒可减少房颤患者的心律失常复发。（由维多利亚州政府运营基础设施支持计划等资助；澳大利亚和新西兰临床试验注册编号，ACTRN12616000256471.）。
