Effect of whiskey on atrial vulnerability and “holiday heart”

Abstract

Vulnerability to atrial fibrillation and flutter was examined in 11 alcohol abusers who did not have cardiomyopathy or manifest heart failure. Atrial extrastimulation was done with rapid pacing (drive cycle length 500 ms) to facilitate induction of atrial vulnerability, seen in four alcohol abusers. The remaining seven were retested 30 minutes after drinking 60 to 120 ml of 86 proof whiskey (ethanol blood levels were 49 to 101 mg/100 ml but pulmonary capillary wedge pressure remained normal in all) and atrial fibrillation or flutter was induced in three of the drinkers. Three nondrinkers, symptomatic with sinus bradycardia but not in heart failure, were found not to be vulnerable to atrial fibrillation or flutter, but flutter was induced in two of the three after drinking whiskey. Whiskey did not alter atrial functional refractory periods (mean +/- standard error of the mean 297 +/- 14 to 290 +/- 12 ms) or widen the dispersion among three disparate right atrial sites (57 +/- 13 to 47 +/- 12 ms). Thus, whiskey enhanced vulnerability to atrial fibrillation and flutter in patients without heart failure or cardiomyopathy, substantiating the "holiday heart" syndrome.

Holiday Heart Syndrome Revisited after 34 Years

“…Nevertheless Ettinger et al 14 also describe the case of a healthy non-regular drinker who presented with AF after alcohol consumption, hinting that HHS could also occur in this group of subjects. This was later confirmed by other studies showing similar cases of sudden onset of cardiac arrhythmias after heavy drinking in non-alcoholic healthy people 7,16 . …”

Impact of Alcohol Consumption on Atrial Fibrillation Outcomes Following Pulmonary Vein Isolation

“…[17], [18] Several pathologic mechanisms and electrophysiologic changes of the underlying cardiac substrate have been described. [19]- [25] Furthermore, chronic alcohol can be associated with other traditional risk factors, such as hypertension, and promote atrial fibrosis and subsequently AF. [26] Conflicting Evidence Regarding Alcohol Consumption and Atrial Fibrillation Several studies have shown a deleterious relationship between the increased daily amount of consumed alcohol and the incidence of AF.…”

Alcohol and cardiac arrhythmias.

“…Patients (especially men) admitted for idiopathic atrial fibrillation have been shown to have consumed more alcohol during the week preceding their admission than either control patients4 or the population outside hospital.5 In one study 60% ofpatients with idiopathic atrial fibrillation coming on at the weekend were problem drinkers, according to the CAGE questionnaire,9 compared with only 12% in the community."' The association of alcohol with other types of supraventricular tachyarrhythmias is less clear," but in the Kaiser Permanente study people consuming more than six drinks a day had a higher risk of all supraventricular tachyarrhythmias than people matched for age, sex, race, and smoking but consuming less than one drink a day.6 Finally, alcohol has occasionally also been shown to promote the onset of ventricular tachyarrhythmias.i 8 How might alcohol promote arrhythmias? Subclinical alcoholic disease of the heart muscle may contribute by producing patchy delays in conduction, and potassium and magnesium depletion may also be factors,' as may the hyperadrenergic state accompanying alcohol withdrawal.…”

“…These complications occurred, respectively, in 6% and 4% of patients. 8 The main indication for enteral nutrition is difficulty in swallowing in patients with neurological disease. Pulmonary aspiration is a serious hazard for those who are unable to protect their airway, yet it is precisely these patients in whom some form of nutrition must be established.…”

“…IIn another study, however, none of 30 patients with a range of neurological lesions developed pneumonia during 6-12 months of feeding by gastrostomy. 8 Most importantly, however, the clear superiority of gastrostomy feeding over the nasoenteral route is in allowing patients to receive sustained nutritional support. Successful tube insertion, which occurs in more than 95% of cases in large series, improves body composition and nutritional status with sustained weight gain being the rule during follow up of a year or more.…”