Will drinking alcohol or caffeinated drinks trigger my atrial fibrillation?

Q. I've had three past attacks of a heart rhythm problem, atrial fibrillation. I'm okay now. The doctor says drinking alcohol or drinks with caffeine can make it start again. Is that true?

A. I'm afraid it's at least half true. A group of experts from the American Heart Association and other prestigious organizations reviewed the evidence about your question in the medical journal Circulation, published Jan. 2, 2024.

Atrial fibrillation (afib) is, unfortunately, pretty common: about 9% of people ages 65 or older in the United States have it. It's more likely to occur in people with high blood pressure, coronary artery disease, heart failure, obesity, diabetes, an overactive thyroid gland, sleep apnea, or other conditions. Like you, I'm someone who has had several attacks of afib in the past.

Afib is a condition in which the heart's two upper chambers, the atria, start beating erratically. Instead of pumping blood effectively down into the lower chambers of the heart, the walls of the atria start quivering. As a result, the heartbeat becomes irregular and usually more rapid. Some people feel breathless. Also, blood tends to pool in the quivering atria, and clots can form. And if clots form, they can travel in the bloodstream to the brain, causing a stroke.

So, you don't want to go back into atrial fibrillation; I sure don't. As for alcohol, I'm afraid the evidence is pretty strong that alcoholic beverages can increase your risk of another attack of afib. Studies find that alcohol in the blood makes the heart more likely to develop afib. And randomized trials have shown that people with recurring afib who are assigned to be abstinent are less likely to have another attack than people who are not abstinent. For people like you, the experts recommend no more than three alcoholic drinks per week.

What about caffeine? Here, the news is better. Both observational studies and randomized trials have found that drinking caffeinated beverages in "usual amounts" does not increase the risk of a new attack of afib. However, each of us is different. If you think caffeine may have triggered a past attack, I would avoid it; you could be especially sensitive to caffeine. What's a "usual amount" of caffeine? I limit myself to two cups of coffee in the morning. And I surely avoid energy drinks containing high doses of caffeine.

Speaking of lifestyle, being physically active — like brisk walking for 150 minutes per week — and not using tobacco also protect you from a recurrent attack.

Unlike you and me, some people have afib constantly, and will for the rest of their lives. So, placing limits on alcoholic or caffeine-containing beverages won't help with their afib, but it will have other health benefits.

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