A Randomized, Double-Blind, Placebo-Controlled Trial of Intravenous Alcohol to Assess Changes in Atrial Electrophysiology
Autor: | Vasanth Vedantham, Gregory Nah, Vijay A. Ramchandani, Eric Vittinghoff, Zian H. Tseng, Shannon M Fan, Edward P. Gerstenfeld, Tomos E. Walters, Kelsey Ogomori, Gregory M. Marcus, Joshua D. Moss, Jeffrey E. Olgin, Byron K. Lee, Rachel A. Gladstone, Nitish Badhwar, Melvin M. Scheinman, Jonathan W. Dukes, Emily Lee, Trisha F. Hue, Christina D. Fang, Randall J. Lee, Henry H. Hsia |
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Rok vydání: | 2020 |
Předmět: |
medicine.medical_specialty
Alcohol Drinking medicine.medical_treatment Placebo-controlled study Alcohol 030204 cardiovascular system & hematology Alcohol exposure Article Double blind 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Double-Blind Method Heart Conduction System Internal medicine Atrial Fibrillation medicine Humans cardiovascular diseases 030212 general & internal medicine Atrial electrophysiology Heart Atria skin and connective tissue diseases business.industry Atrial fibrillation Ablation medicine.disease Electrophysiology chemistry Pulmonary Veins cardiovascular system Cardiology Blood Alcohol Content sense organs Cardiac Electrophysiology business |
Zdroj: | JACC Clin Electrophysiol |
ISSN: | 2405-5018 |
Popis: | This study sought to identify acute changes in human atrial electrophysiology during alcohol exposure.The mechanism by which a discrete episode of atrial fibrillation (AF) occurs remains unknown. Alcohol appears to increase the risk for AF, providing an opportunity to study electrophysiologic effects that may render the heart prone to arrhythmia.In this randomized, double-blinded, placebo-controlled trial, intravenous alcohol titrated to 0.08% blood alcohol concentration was compared with a volume and osmolarity-matched, masked, placebo in patients undergoing AF ablation procedures. Right, left, and pulmonary vein atrial effective refractory periods (AERPs) and conduction times were measured pre- and post-infusion. Isoproterenol infusions and burst atrial pacing were used to assess AF inducibility.Of 100 participants (50 in each group), placebo recipients were more likely to be diabetic (22% vs. 4%; p = 0.007) and to have undergone a prior AF ablation (36% vs. 22%; p = 0.005). Pulmonary vein AERPs decreased an average of 12 ms (95% confidence interval: 1 to 22 ms; p = 0.026) in the alcohol group, with no change in the placebo group (p = 0.98). Whereas no statistically significant differences in continuously assessed AERPs were observed, the proportion of AERP sites tested that decreased with alcohol (median: 0.5; interquartile range: 0.6 to 0.6) was larger than with placebo (median: 0.4; interquartile range: 0.2 to 0.6; p = 0.0043). No statistically significant differences in conduction times or in the proportion with inducible AF were observed.Acute exposure to alcohol reduces AERP, particularly in the pulmonary veins. These data demonstrate a direct mechanistic link between alcohol, a common lifestyle exposure, and immediate proarrhythmic effects in human atria. (How Alcohol Induces Atrial Tachyarrhythmias Study [HOLIDAY]; NCT01996943). |
Databáze: | OpenAIRE |
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