Should You Drink Alcohol When You Have A-Fib?

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Especially during the holiday season, or during weddings, graduations or other occasions for celebration where alcohol is consumed, it is not uncommon for otherwise healthy young individuals to develop episodes of atrial fibrillation. The onset of atrial fibrillation after such celebrations is a condition commonly known as “Holiday Heart.”

Atrial Fibrillation And Holiday Heart

Atrial fibrillation is a fairly common heart rhythm disturbance that often produces significant symptoms, especially easy fatiguability and palpitations.

The main significance of atrial fibrillation, however, is that it can lead to stroke. Atrial fibrillation is a rapid and irregular cardiac arrhythmia, caused by chaotic electrical impulses in the atria of the heart (the two upper chambers). (Read about the heart’s chambers and valves.)

In most cases, the atrial fibrillation that occurs with Holiday Heart is "paroxysmal” — which means that the arrhythmia begins very suddenly, and after some period of time it stops equally suddenly. People who experience this condition will have the sudden onset of symptoms. They may notice a rapid, irregular heart rate; dyspnea (shortness of breath), especially with any exertion; and often dizziness. When their doctors record an ECG during one of these episodes, they will see that atrial fibrillation is the cause of the symptoms. 

What Causes Holiday Heart?

In many people who develop atrial fibrillation, the arrhythmia is caused by underlying heart disease, aging, hypertension, obesity or a sedentary lifestyle.

In many other people with this arrhythmia no cause at all can be identified. 

But in Holiday Heart, the atrial fibrillation is caused by alcohol consumption.

Alcohol and Atrial Fibrillation

We know that chronic, heavy drinking is associated with an increased risk of developing atrial fibrillation. Heavy alcohol consumption is also associated with a form of dilated cardiomyopathy and heart failure.

So there’s no question that heavy, long-term drinking is bad for the heart.

However, studies have failed to define a definite cause-and-effect relationship between more moderate long-term alcohol consumption and an increased risk of atrial fibrillation. 

Alcohol and Holiday Heart

Holiday Heart, on the other hand, is not associated with chronic alcohol consumption of any kind. Instead, it is associated with binge drinking, of the kind that people typically engage in during the holidays, or during a celebration. Typically the binge is a real “binge,” with very heavy alcohol intake over a relatively short period of time (hours or a day or so), and the atrial fibrillation is accompanied by all the other unpleasant side effects that often accompany such episodes. Other kinds of overindulgences often accompany these binges, including eating a lot of food that is bad for you, or taking drugs. While these other factors may play a role in developing Holiday Heart, the only factor that is virtually always present with Holiday Heart is alcohol. In fact, it is estimated that up to 60% of people who engage in heavy binge drinking will eventually develop episodes of atrial fibrillation as a result.

This variety of Holiday Heart — where the atrial fibrillation occurs after an obvious episode of binge drinking — is the most common form of this condition. Doctors are well aware of this more obvious variety of Holiday Heart, and generally have no problem in making the correct diagnosis. They will also get the treatment right, namely, advising the victim to avoid binge drinking in the future.

A More Subtle Form of Holiday Heart

There appears to be a much more subtle form of Holiday Heart, in which atrial fibrillation is found, but a history of true binge drinking is not. It turns out that some people are simply extremely sensitive to alcohol.

In these individuals, even moderate amounts — typically two or three drinks, and sometimes a single drink — can trigger episodes of atrial fibrillation.

Ironically, this milder kind of Holiday Heart may end up posing a bigger problem for the victim than the more typical, more severe kind. The problem is that this more subtle form of alcohol-induced atrial fibrillation can be easily overlooked by a doctor. 

And if the association between the paroxysmal atrial fibrillation and alcohol ingestion is missed (because there really hasn't been very much alcohol ingestion, and no "binging"), the doctor may be led to recommend chronic therapy for atrial fibrillation, treatment which can be quite unpleasant or even risky. The appropriate therapy for these people, of course, is simply to avoid drinking alcohol. For someone who has had an episode of Holiday Heart after a small amount of alcohol, that pretty much means avoiding any alcohol in the future.

This milder form of Holiday Heart may be more common than is currently recognized. People who have episodes of paroxysmal atrial fibrillation should carefully consider the circumstances in which this arrhythmia has occurred, to see whether it seems to be related in any way to alcohol consumption. And doctors who treat patients with paroxysmal atrial fibrillation should be careful to ask about even minor exposure to alcohol. In fact, the doctor should examine other aspects of the patient’s lifestyle, since atrial fibrillation is a “lifestyle disease”much more often than most doctors currently realize. By making the proper diagnosis, they may spare their patient from inappropriate treatments.

Sources:

Constantini, O. and Stambler, B. Approach to the Patient with Atrial Fibrillation. In: Management of Cardiac Arrhythmias, Ganz LI and Braunwald E. Eds. Humana Press, Totowa, NJ.; 2002.

Djoussé L, Levy D, Benjamin EJ, et al. Long-term Alcohol Consumption and the Risk of Atrial Fibrillation in the Framingham Study. Am J Cardiol 2004; 93:710.

Frost L, Vestergaard P. Alcohol and rRsk of Atrial Fibrillation or Flutter: a Cohort Study. Arch Intern Med 2004; 164:1993.

Mukamal KJ, Psaty BM, Rautaharju PM, et al. Alcohol Consumption and Risk and Prognosis of Atrial Fibrillation Among Older Adults: the Cardiovascular Health Study. Am Heart J 2007; 153:260.

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