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Acute Alcohol Consumption and Arrhythmias in Young Adults
TAKE-HOME MESSAGE
- In this prospective cohort study, acute alcohol consumption was associated with an increased heart rate and increased risks of atrial tachycardia and premature ventricular contractions. Heart rate variability analyses indicated heightened sympathetic activity during periods of acute alcohol exposure.
- These findings enhance our understanding of the proarrhythmic effects of acute alcohol consumption, with important implications for both primary and secondary prevention strategies.
abstract
This abstract is available on the publisher's site.
Access this abstract nowBACKGROUND
and aims: Acute excessive alcohol intake may cause the holiday heart syndrome, characterized by cardiac arrhythmias including atrial fibrillation. Since underlying data are scarce, the study aimed to prospectively investigate the temporal course of occurring cardiac arrhythmias following binge drinking in young adults.
METHODS
A total of 202 volunteers planning acute alcohol consumption with expected peak breath alcohol concentrations (BAC) of ≥1.2 g/kg were enrolled. The study comprised 48-hour electrocardiogram (ECG) monitoring covering baseline (hour 0), 'drinking period' (hours 1-5), 'recovery period' (hours 6-19), and two control periods corresponding to 24 hours after the 'drinking' and 'recovery periods', respectively. Acute alcohol intake was monitored by BAC measurements during the 'drinking period'. ECGs were analyzed for mean heart rate, atrial tachycardia, premature atrial complexes (PAC), premature ventricular complexes (PVC), and heart rate variability (HRV) measures.
RESULTS
Data revealed an increase in heart rate and an excess of atrial tachycardias with increasing alcohol intake. HRV analysis indicated an autonomic modulation with sympathetic activation during alcohol consumption and the subsequent 'recovery period', followed by parasympathetic predominance thereafter. PACs occurred significantly more frequently in the 'control periods', whereas PVCs were more frequent in the 'drinking period'. Ten participants experienced notable arrhythmic episodes, including atrial fibrillation and ventricular tachycardias, primarily during the 'recovery period'.
CONCLUSIONS
The study demonstrates the impact of binge drinking on heart rate alterations and increased atrial tachycardias during 'drinking period', and the occurrence of clinically relevant arrythmias during the 'recovery period', emphasizing the holiday heart syndrome as a health concern.
Additional Info
Disclosure statements are available on the authors' profiles:
Acute Alcohol Consumption and Arrhythmias in Young Adults: The MunichBREW II Study
Eur Heart J 2024 Oct 04;[EPub Ahead of Print], S Brunner, C Krewitz, R Winter, AS von Falkenhausen, A Kern, D Brunner, MF SinnerFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Prospective Observations of “The Holiday Heart”
Alcohol intake, especially excessive alcohol intake, is associated with an increase in both atrial and ventricular arrhythmias; however, atrial fibrillation is more closely associated with alcohol intake as part of the “holiday heart syndrome.” Brunner and colleagues recruited 202 participants who were planning to consume enough alcohol to achieve a blood alcohol concentration of more than 1.2 g/kg of body weight. They sought to prospectively evaluate the effect of alcohol on cardiac rhythm. The participants' average age was approximately 30 ± 10 years, 64% were men, and their habitual intake was 6.8 alcoholic drinks weekly. Cardiac rhythm and sympathetic tone (estimated by heart rate variability) were assessed using a three-lead ECG patch before drinking, during 1 to 5 hours of drinking, 6 to 19 hours of recovery, and during two control periods of 1 to 5 and 6 to 19 hours after recovery. Alcohol intake was recorded by study staff during the drinking period.
The participants reached a blood alcohol concentration of 1.4 g/kg. Heart rate increased during drinking, whereas variability in the R-to-R intervals decreased, suggesting decreased vagal tone. Atrial tachycardia episodes increased during drinking as did premature ventricular contractions; however, probable atrial fibrillation (n = 2), nonsustained ventricular tachycardia of 12 and 8 beats (n = 2), and complete heart block (n = 2; up to 15.4 seconds) occurred during recovery. Of the 193 participants (5.2%) with usable data, 10 experienced some significant arrhythmia, which the authors noted is higher than expected compared with other data.
This is a well-designed, careful study and one of the few to prospectively observe cardiac rhythm during excessive drinking. Despite the study's size and heart rate data, the findings are largely anecdotal. The key clinical takeaway is that alcohol increased both atrial and ventricular arrhythmias, and clinicians should consider alcohol intake, especially excessive intake, in patients with new or worsening cardiac arrhythmias; thus, alcohol avoidance should likely be part of the treatment plan.