To the Editor.—
It seems that despite the clear history, the consultant has failed to consider that alcohol may be the culprit in triggering paroxysmal atrial fibrillation (AF) in this 63-year-old male athlete.1 The submitter of the question stated that AF occurred after consumption of a "substantial amount of wine," which was paraphrased by the consultant into "moderate amount of alcohol." Neither defines what is "substantial" or "moderate."Even in the absence of overt heart disease, a "substantial" consumption of alcohol may induce acute AF.2 Up to 35% of patients presenting with net onset AF at a public hospital were intoxicated with alcohol.3 The AF in the patient in question may have spontaneously reverted to normal sinus rhythm after the alcohol effect on the heart waned. Current thoughts of possible mechanisms of how alcohol could cause arrhythmias include (1) alcohol-promoted secretion of epinephrine and norepinephrine by the
Carethers M. Paroxysmal Atrial Fibrillation in a Physically Active Man. JAMA. 1988;260(20):3005–3006. doi:10.1001/jama.1988.03410200049017
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