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BOSTON, Sept. 12-Men who drink more than a case of beer a week -- or an average of at least 35 mixed drinks weekly -- have 45% greater risk for developing atrial fibrillation than non-drinkers, researchers reported today.

But moderate drinking does not increase risk of atrial fibrillation in either men or women, said a team of researchers from Beth Israel Deaconess Medical Center here who reported their findings in the Sept. 13 issue of Circulation, Journal of the American Heart Association.

On the basis of this analysis the researchers estimated that about 5% of cases of atrial fibrillation among men are attributable to heavy drinking. There was no link between alcohol consumption and atrial fibrillation in women, but they noted that few women consumed 35 or more drinks a week.

Kenneth J. Mukamal, M.D., M.P.H., of Harvard Medical School, and colleagues analyzed data from the 16,415 patient Copenhagen City Heart Study, a prospective cohort study.

"This was certainly the largest study of its type to examine this topic," he said. "And while it is reassuring that moderate drinkers did not seem to have an increased risk of this hazardous heart rhythm, our findings provide yet more evidence of the risks of heavy drinking to the heart."

The observed link between heavy drinking and atrial fibrillation supports the existence of the so-called holiday heart syndrome, said Dr. Mukamal. Holiday heart, he said, refers to heart rhythm disturbances that are reported by vacationers, when people are likely to be drinking heavier-than-normal amounts of alcohol.

"Since our research found that the risk of developing atrial fibrillation begins to increase at about four drinks per day, and clearly goes up at five drinks per day, this would seem to confirm what has long been suspected regarding periods of significant alcohol consumption, like during vacations."

The Copenhagen study recruited 7,588 men and 8,827 women, mean age 50. All participants underwent routine electrocardiograms on three separate occasions between 1976 and 1994.

Participants reported alcohol use in standardized interviews that tracked consumption of beer, wine and spirits.

The researchers documented 1,071 cases of atrial fibrillation during the study period.

There was no difference in risk of atrial fibrillation between non-drinkers and moderate drinkers -- defined as drinking fewer than 14 drinks a week.

Dr. Mukamal's group proposed a number of mechanisms to explain the link between alcohol and atrial fibrillation including the possibility that heavy drinking may act as a cardiotoxin and change atrial structure and size, an effect suggested by experiments in rats.

"Second, chronic heavy drinking could have direct proarrhythmic effects. Third, heavier drinkers are likely to have repeated exposure to episodic heavy drinking (i.e. binge drinking), which could increase the risk of triggering a single episode of AF," they wrote.

As the authors pointed out, "participants in this database are nearly all white, native-born Danish adults. As a result, our results must be generalized to other populations with an appropriate degree of caution."

They concluded that studies of the effect of alcohol use in patients with established atrial fibrillation are also needed.

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