Holiday Heart Syndrome: The Impact of Excessive Alcohol Consumption on Cardiac Arrhythmias

Studies indicate that excessive alcohol consumption is directly linked to cardiac arrhythmias such as atrial fibrillation (AF) (1). Understand how this affects young and healthy individuals and the challenges in treatment.

Excessive alcohol consumption has complex effects on cardiovascular health, influencing the risk of conditions such as hypertension, coronary artery disease, stroke, peripheral artery disease, and cardiomyopathy. These associations are shaped by various factors, including behavioral, genetic, and biological variations. Additionally, the dose and pattern of alcohol consumption also seem to play a crucial role in modulating this relationship (2). Consuming five or more drinks within a two-hour period can have serious health consequences, including for the heart.

"Holiday Heart Syndrome" (HHS) is named for its association with the occurrence of cardiac arrhythmias triggered by episodes of excessive alcohol consumption, which often occur during weekends and holidays, periods marked by increased relaxation and celebrations. Atrial fibrillation (AF) is the most commonly diagnosed arrhythmia among patients with HHS. AF is widely known for increasing the risk of morbidity and mortality, primarily due to strokes (CVA) and heart failure, representing a significant burden on healthcare systems.

Atrial fibrillation caused by excessive alcohol consumption occurs due to various mechanisms that disrupt the heart's functioning. Alcohol can interfere with calcium regulation inside cardiac cells, disrupting its release and causing electrical changes that may lead to irregular heartbeats (3). Additionally, a hangover increases the activity of the nervous system, making the heart more sensitive and decreasing the time it needs to recover between beats, which facilitates arrhythmias (4). Alcohol also causes the loss of important electrolytes due to its diuretic effect and can damage heart cells through the accumulation of toxic substances, contributing to the development of AF (5).

Treatment of Holiday Heart Syndrome goes beyond initial stabilization in the emergency room. It is essential to understand the reasons behind excessive alcohol consumption, and evaluation with a mental health professional is recommended. Reducing the effects of alcohol consumption can only be achieved with the collaboration of a well-coordinated interdisciplinary team (6).

References:

1. Voskoboinik A, Prabhu S, Ling LH, Kalman JM, Kistler PM. Alcohol and Atrial Fibrillation: A Sobering Review. J Am Coll Cardiol. 2016 Dec 13;68(23):2567–76. 
2. Piano M. R. (2017). Alcohol's Effects on the Cardiovascular System. Alcohol research : current reviews, 38(2), 219–241.
3. Yan, J., Thomson, J. K., Zhao, W., Gao, X., Huang, F., Chen, B., Liang, Q., Song, L. S., Fill, M., & Ai, X. (2018). Role of Stress Kinase JNK in Binge Alcohol-Evoked Atrial Arrhythmia. Journal of the American College of Cardiology, 71(13), 1459–1470. https://doi.org/10.1016/j.jacc.2018.01.060
4. Marcus, G. M., Dukes, J. W., Vittinghoff, E., Nah, G., Badhwar, N., Moss, J. D., Lee, R. J., Lee, B. K., Tseng, Z. H., Walters, T. E., Vedantham, V., Gladstone, R., Fan, S., Lee, E., Fang, C., Ogomori, K., Hue, T., Olgin, J. E., Scheinman, M. M., Hsia, H., … Gerstenfeld, E. P. (2021). A Randomized, Double-Blind, Placebo-Controlled Trial of Intravenous Alcohol to Assess Changes in Atrial Electrophysiology. JACC. Clinical electrophysiology, 7(5), 662–670. https://doi.org/10.1016/j.jacep.2020.11.026
5. Tonelo, D., Providência, R., & Gonçalves, L. (2013). Holiday heart syndrome revisited after 34 years. Arquivos brasileiros de cardiologia, 101(2), 183–189. https://doi.org/10.5935/abc.20130153
6. Jain A, Yelamanchili VS, Brown KN, et al. Holiday Heart Syndrome. [Updated 2024 Jan 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537185/