Holiday Heart Syndrome

Holiday Heart Syndrome


Holiday Heart Syndrome is the name given to atrial fibrillation which occurs after binge drinking. The original description was in 1978 by Ettinger PO et al. [1]. This study reported 32 arrhythmic episodes in 24 patients. There was spontaneous recovery with abstinence from alcohol.
Holiday heart syndrome should be considered in the differential diagnosis of new onset atrial fibrillation in those without structural heart disease. In one study, alcohol was thought to be the causative agent for 35% cases of new onset atrial fibrillation. The amount of alcohol needed to precipitate it is variable. Greenspon AJ et al evaluated 14 patients with history of rhythm disturbances and alcohol consumption [2]. They could induce atrial or ventricular tachyarrhythmias in 10 of them with programmed stimulation after intake of alcohol while only two had it before the intake of alcohol. Significant prolongation of HV interval was also noted.

A case of cardiac arrest after an alcohol binge has also been reported in literature [3]. Ventricular fibrillation was documented and successfully resuscitated. Dual AV nodal pathways were documented on EP study. AV nodal effective refractory period was 210 ms so that on induction of atrial fibrillation, fast ventricular response and hemodynamic collapse occurred. Radiofrequency catheter modification of AV node was done and he had no recurrence after abstaining from alcohol.

Though atrial fibrillation in holiday heart syndrome usually reverts on with holding alcohol, one report documented no relief after four days and required electrical cardioversion for reversion to sinus rhythm [4].
An updated review on the data compiled 34 years after the original description of holiday heart syndrome has been published by David Tonelo and colleagues [5].

References

  1. Ettinger PO, Wu CF, De La Cruz C Jr, Weisse AB, Ahmed SS, Regan TJ. Arrhythmias and the “Holiday Heart”: alcohol-associated cardiac rhythm disorders. Am Heart J. 1978 May;95(5):555-62.
  2. Greenspon AJ, Schaal SF. The “holiday heart”: electrophysiologic studies of alcohol effects in alcoholics. Ann Intern Med. 1983 Feb;98(2):135-9.
  3. Fuenmayor AJ, Fuenmayor AM. Cardiac arrest following holiday heart syndrome. Int J Cardiol. 1997 Mar;59(1):101-3.
  4. Carey MG, Al-Zaiti SS, Kozik TM, Pelter M. Am J Crit Care. 2014 Mar;23(2):171-2.
  5. Tonelo D, ProvidĂȘncia R, Gonçalves L. Arq Bras Cardiol. 2013 Aug;101(2):183-9.