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Does the holiday heart syndrome extend to the ventricles?

  • Stacey J. Howell
    Affiliations
    Section of Electrophysiology, Division of Cardiology, University of California San Francisco, San Francisco, California
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  • Gregory M. Marcus
    Correspondence
    Address reprint requests and correspondence: Dr Gregory M. Marcus, Section of Electrophysiology, Division of Cardiology, University of California San Francisco, 505 Parnassus Avenue, M-1180B, Box 0124, San Francisco, CA 94143.
    Affiliations
    Section of Electrophysiology, Division of Cardiology, University of California San Francisco, San Francisco, California
    Search for articles by this author
Published:November 15, 2021DOI:https://doi.org/10.1016/j.hrthm.2021.11.018
      The relationship between alcohol consumption and cardiovascular health is complex. While observational studies have consistently revealed a J-shaped association between alcohol and cardiovascular mortality,
      • Mukamal K.J.
      • Chen C.M.
      • Rao S.R.
      • Breslow R.A.
      Alcohol consumption and cardiovascular mortality among U.S. adults, 1987 to 2002.
      the most compelling and consistent evidence in the realm of alcohol and cardiology falls in the category of cardiac electrophysiology, specifically that alcohol heightens the risk of atrial fibrillation (AF). Whether chronic consumption is assessed as a predictor of the eventual diagnosis of the disease
      • Dukes J.W.
      • Dewland T.A.
      • Vittinghoff E.
      • et al.
      Access to alcohol and heart disease among patients in hospital: observational cohort study using differences in alcohol sales laws.
      or acute consumption is evaluated as a harbinger of a discrete AF episodes only a few hours later,
      • Marcus G.M.
      • Vittinghoff E.
      • Whitman I.R.
      • et al.
      Acute consumption of alcohol and discrete atrial fibrillation events.
      more alcohol is associated with a higher AF risk. Two recent randomized trials provide the final hammer blow in this arena.
      • Voskoboinik A.
      • Kalman J.M.
      • De Silva A.
      • et al.
      Alcohol abstinence in drinkers with atrial fibrillation.
      ,
      • Marcus G.M.
      • Dukes J.W.
      • Vittinghoff E.
      • et al.
      A randomized, double-blind, placebo-controlled trial of intravenous alcohol to assess changes in atrial electrophysiology.
      In 1 case, random assignment to an ethanol solution but not a double-blinded placebo infusion immediately resulted in a reduction in pulmonary vein effective refractory periods, an electrical change expected to render the atria more prone to fibrillate.
      • Marcus G.M.
      • Dukes J.W.
      • Vittinghoff E.
      • et al.
      A randomized, double-blind, placebo-controlled trial of intravenous alcohol to assess changes in atrial electrophysiology.
      In another case, patients with AF randomized to abstain from alcohol enjoyed reductions in AF recurrence and overall AF burden compared with their counterparts in a control arm.
      • Voskoboinik A.
      • Kalman J.M.
      • De Silva A.
      • et al.
      Alcohol abstinence in drinkers with atrial fibrillation.
      Indeed, this relationship between alcohol and AF has long been referred to as the holiday heart syndrome.
      • Ettinger P.O.
      • Wu C.F.
      • De La Cruz C.
      • Weisse A.B.
      • Ahmed S.S.
      • Regan T.J.
      Arrhythmias and the “Holiday Heart”: alcohol-associated cardiac rhythm disorders.
      Is there some reason this phenomenon should be constrained only to the atria?
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      References

        • Mukamal K.J.
        • Chen C.M.
        • Rao S.R.
        • Breslow R.A.
        Alcohol consumption and cardiovascular mortality among U.S. adults, 1987 to 2002.
        J Am Coll Cardiol. 2010; 55: 1328-1335
        • Dukes J.W.
        • Dewland T.A.
        • Vittinghoff E.
        • et al.
        Access to alcohol and heart disease among patients in hospital: observational cohort study using differences in alcohol sales laws.
        BMJ. 2016; 353: i2714
        • Marcus G.M.
        • Vittinghoff E.
        • Whitman I.R.
        • et al.
        Acute consumption of alcohol and discrete atrial fibrillation events.
        Ann Intern Med. 2021; 174: 1503-1509
        • Voskoboinik A.
        • Kalman J.M.
        • De Silva A.
        • et al.
        Alcohol abstinence in drinkers with atrial fibrillation.
        N Engl J Med. 2020; 382: 20-28
        • Marcus G.M.
        • Dukes J.W.
        • Vittinghoff E.
        • et al.
        A randomized, double-blind, placebo-controlled trial of intravenous alcohol to assess changes in atrial electrophysiology.
        JACC Clin Electrophysiol. 2021; 7: 662-670
        • Ettinger P.O.
        • Wu C.F.
        • De La Cruz C.
        • Weisse A.B.
        • Ahmed S.S.
        • Regan T.J.
        Arrhythmias and the “Holiday Heart”: alcohol-associated cardiac rhythm disorders.
        Am Heart J. 1978; 95: 555-562
        • Tu S.J.
        Consumption and risk of ventricular arrhythmias and sudden cardiac death: an observational study of 408,712 individuals.
        Heart Rhythm. 2021; (XX:XX–XX)
        • Skourlis N.
        • Massara P.
        • Patsis I.
        • Peppa E.
        • Katsouyanni K.
        • Trichopoulou A.
        Long-term trends (1994-2011) and predictors of total alcohol and alcoholic beverages consumption: the EPIC Greece cohort.
        Nutrients. 2021; 13: 3077
        • Livingston M.
        • Callinan S.
        Underreporting in alcohol surveys: whose drinking is underestimated?.
        J Stud Alcohol Drugs. 2015; 76: 158-164
        • Khan A.
        • Ramsey K.
        • Ballard C.
        • et al.
        Limited accuracy of administrative data for the identification and classification of adult congenital heart disease.
        J Am Heart Assoc. 2018; 7e007378
        • Tseng Z.H.
        • Olgin J.E.
        • Vittinghoff E.
        • et al.
        Prospective countywide surveillance and autopsy characterization of sudden cardiac death: POST SCD Study.
        Circulation. 2018; 137: 2689-2700
        • Whitman I.R.
        • Pletcher M.J.
        • Vittinghoff E.
        • et al.
        Perceptions, information sources, and behavior regarding alcohol and heart health.
        Am J Cardiol. 2015; 116: 642-646
        • Whitman I.R.
        • Agarwal V.
        • Nah G.
        • et al.
        Alcohol abuse and cardiac disease.
        J Am Coll Cardiol. 2017; 69: 13-24

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