Alcohol and Illicit Drug Use in the Young: Precipitants of Atrial Fibrillation

Suresh Krishnamoorthy, MRCP, Gregory Y. H. Lip, MD, Deirdre A. Lane, PhD. Alcohol and Illicit Drug Use as Precipitants of Atrial Fibrillation in Young Adults: A Case Series and Literature Review. Am J of Medicine 22(9) (Sept. 2009):851-856.e3

METHODS: We retrospectively analyzed young (defined as under 45 years) patients with “lone” atrial fibrillation who were admitted to the hospital with electrocardiographically confirmed diagnosis of atrial fibrillation or atrial flutter, precipitated by either alcohol or illicit drugs, over a 6-year period.
RESULTS: Eighty-eight patients aged under 45 years were admitted with atrial fibrillation or atrial flutter. In 22 patients, (mean [SD] age 33.6 [8.4] years; 20 male), alcohol and/or illicit drugs were found to be the precipitant. One patient required electrical cardioversion, with the remaining patients cardioverting back to sinus rhythm either pharmacologically or spontaneously. Twelve (54.5%) were investigated for atrial fibrillation burden by 24-hour Holter monitoring and the majority also underwent a transthoracic echocardiogram (81.8%). At discharge, 14 (63.6%) patients were treated with anti-arrhythmic drugs and 10 received either antiplatelets or anticoagulants. Most (85%) patients were followed-up for at least 12 months, during which time 6 had further paroxysms; all of whom continued to abuse either alcohol or illicit drugs.
CONCLUSIONS: Alcohol and illicit drugs are arrhythmogenic and are associated with atrial fibrillation. Apart from abstinence, the optimal management of such patients and the long-term effects of these substances on the heart and atrial fibrillation recurrences are still unclear.

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