Holiday Heart Syndrome

Holiday heart syndrome refers to atrial fibrillation induced by excessive alcohol consumption.

During the holiday season—or weddings, graduations, or other occasions—when more alcohol than usual is often consumed, it is common for otherwise healthy young people to develop episodes of atrial fibrillation.

This article discusses atrial fibrillation, its causes, and its association with alcohol consumption.

Atrial Fibrillation and Holiday Heart Syndrome

Atrial fibrillation is a fairly common heart rhythm disturbance that often produces significant symptoms, especially easy fatiguability and palpitations. For some people, holiday heart syndrome may feel like the heart is racing, while others may feel tired, short of breath, or no energy. The real reason that atrial fibrillation is of concern, however, is that it can lead to stroke.

Atrial fibrillation is a rapid and irregular cardiac arrhythmia caused by chaotic electrical impulses in the atrial chambers of the heart (the two upper chambers).

The atrial fibrillation that occurs with holiday heart is caused by episodes of alcohol consumption.

In most cases, the atrial fibrillation that occurs with holiday heart is “paroxysmal,” meaning that the arrhythmia begins very suddenly and, after some time, stops equally as suddenly. People who have episodes of paroxysmal atrial fibrillation commonly experience symptoms of quite sudden onset, often including:

• Palpitations, in particular, noticing a rapid, irregular heart rate
• Dyspnea (shortness of breath), especially with any exertion
• Dizziness

Symptoms of holiday heart syndrome can last anywhere from 12 to 24 hours.

Atrial fibrillation is shown to be the cause when an ECG is recorded during one of these episodes.

In people with the more typical forms of atrial fibrillation (that is, not associated with alcohol or celebrations), the arrhythmia may be caused by:

• Underlying heart disease
• Lung and sleep disorders
• Aging
• Family history
• Hypertension
• Obesity
• Smoking
• Panic disorders
• Types of emotional distress
• Illegal drugs
• A sedentary lifestyle
  

However, in many other people with the usual forms of atrial fibrillation, no cause can be identified.

Alcohol Consumption

We know that chronic, heavy drinking is associated with a form of dilated cardiomyopathy and heart failure, which, in turn, often leads to chronic atrial fibrillation. So there’s no question that heavy, long-term drinking is bad for the heart.

Even much smaller amounts of routine alcohol consumption have been associated with an increase in the risk of atrial fibrillation. There is a measurable increase in the odds of developing atrial fibrillation in populations who consume more than one drink per day, and the risk is increased by almost 40% in those who average more than three drinks per day.

Holiday heart, on the other hand, is not associated with chronic alcohol consumption of any kind. Instead, it is associated with binge drinking—the kind that people typically engage in during the holidays or a celebration. Typically the binge is a real “binge,” with very heavy alcohol intake over a relatively short period of time, and the atrial fibrillation that ensues is accompanied by all the other unpleasant side effects that often accompany binge drinking.

Other kinds of overindulgence may occur during these binges, including eating a lot of unhealthy foods or taking drugs. While these factors may play a role in developing holiday heart syndrome, the only factor that is virtually always present is alcohol.

This variety of holiday heart—where the atrial fibrillation occurs after an obvious episode of binge drinking—is the most common form of this condition. Doctors are well aware of this more obvious variety and usually make the diagnosis easily.

There is no treatment for this condition other than advising the person to avoid binge drinking in the future.

A More Subtle Atrial Fibrillation

There appears to be a much more subtle form of holiday heart syndrome, one in which atrial fibrillation occurs, but a history of true binge drinking is absent. It turns out that some people are extremely sensitive to alcohol. In these individuals, moderate amounts of alcohol (typically two or three drinks), and sometimes even a single drink, can trigger episodes of atrial fibrillation.

Ironically, this milder kind of holiday heart syndrome may end up posing a bigger problem for the person than the more typical, more severe kind. The problem is that without a history of real binge drinking, this more subtle form of alcohol-induced atrial fibrillation can be easily overlooked by a healthcare provider.

If the association between paroxysmal atrial fibrillation and alcohol ingestion is missed (because there hasn't been very much alcohol ingestion and no binge drinking), the healthcare provider may be led to recommend chronic therapy for atrial fibrillation. Such treatment can be quite unpleasant or even risky. In fact, the appropriate treatment for this condition is to avoid drinking alcohol.

This milder form of holiday heart syndrome may be more common than is currently recognized. So, people who have episodes of paroxysmal atrial fibrillation should carefully consider the circumstances in which this arrhythmia has occurred, and try to determine whether it seems to be related in any way to alcohol consumption.

Doctors who treat people with paroxysmal atrial fibrillation should be sure to ask about even minor exposure to alcohol and examine other aspects of the person's lifestyle since atrial fibrillation is a “lifestyle disease" more often than realized. By making the proper diagnosis, they may avoid recommending inappropriate treatments.

Summary

“Classic” holiday heart syndrome refers to the onset of sudden atrial fibrillation after an obvious bout of binge drinking. In addition, some people will have atrial fibrillation after even very moderate alcohol consumption. It is important for doctors to consider even trivial amounts of alcohol ingestion when trying to figure out why a relatively young, healthy person has developed an episode of atrial fibrillation.