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Holiday Heart - Alcohol and Atrial Fibrillation

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Updated October 27, 2013

Especially during the holiday season, or during weddings, graduation or other occasions for celebration, it is not uncommon for otherwise healthy young individuals to develop episodes of atrial fibrillation - a condition known as Holiday Heart.

Atrial fibrillation is a common heart rhythm disturbance that often produces significant symptoms, and can even lead to stroke. It is a rapid and irregular heart arrhythmia, caused by chaotic electrical impulses in the atria of the heart (the two upper chambers).

Most cases of Holiday Heart start as "paroxysmal atrial fibrillation," that is, atrial fibrillation that starts suddenly, and after a time, stops suddenly. Patients will experience the sudden onset of rapid heart rate, palpitations, and often dizziness or shortness of breath. When their doctors do an ECG during one of these episodes, they will see atrial fibrillation.

In most people who have atrial fibrillation, the arrhythmia is caused by underlying heart disease or by aging. Often there is no identifiable reason for atrial fibrillation. But in Holiday Heart, the cause is an unusual sensitivity to alcohol consumption.

While chronic heavy alcohol ingestion is associated with an increased risk of atrial fibrillation, with Holiday Heart, in contrast, atrial fibrillation can be produced by a single large "dose" of alcohol - that is, by binge drinking.  In fact, up to 60% of people who engage in heavy binge drinking will eventually develop episodes of atrial fibrillation.

This phenomenon - atrial fibrillation after an obvious episode of binge drinking - is the most common form of Holiday Heart, and doctors are generally well aware of this condition.

But it turns out that some people are simply extremely sensitive to alcohol, such that even moderate amounts - two or three drinks, and sometimes a single drink - can trigger episodes of atrial fibrillation.

Holiday Heart May Be Overlooked by Doctors

This more subtle form of alcohol-induced atrial fibrillation can be easily overlooked by a doctor. If the association between the paroxysmal atrial fibrillation and alcohol ingestion is missed (because there really hasn't been very much alcohol ingestion, and no "binging"), the doctor may be led to recommending unpleasant or risky therapies - whereas the appropriate therapy is simply to avoid drinking alcohol. Any alcohol.

Patients who have episodes of paroxysmal atrial fibrillation should carefully examine whether the episodes seem in any way to be related to alcohol consumption. And doctors who treat patients with this condition should be careful to ask about even minor exposure to alcohol. Making the proper diagnosis may spare the patient from inappropriate treatments.

Sources:

Constantini, O. and Stambler, B. Approach to the Patient with Atrial Fibrillation. In: Management of Cardiac Arrhythmias, Ganz LI and Braunwald E. Eds. Humana Press, Totowa, NJ.; 2002.

Djoussé L, Levy D, Benjamin EJ, et al. Long-term alcohol consumption and the risk of atrial fibrillation in the Framingham Study. Am J Cardiol 2004; 93:710.

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