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Acute Alcohol Consumption and Arrhythmias in Young Adults
Quick Takes
- Increased heart rate and excess atrial tachycardia were associated with increasing alcohol intake.
- Premature atrial complexes occurred significantly more frequently in the control periods, whereas premature ventricular complexes were more frequent in the drinking period.
- Ten participants experienced AF and/or ventricular tachycardias, primarily during the recovery period.
Study Questions:
What is the temporal course of cardiac arrhythmias following binge drinking in young adults?
Methods:
This single-arm prospective cohort study enrolled healthy volunteers between October 2016 and July 2017, who were planning acute alcohol consumption. Anticipated intake was estimated to cause an estimated peak breath alcohol concentration (BAC) of ≥1.2 g/kg. Adults with a history of atrial fibrillation (AF) or cardiac implantable devices and those who reported medical advice to avoid alcohol were excluded. Electrocardiogram (ECG) monitoring over 48 hours was completed at baseline (hour 0), the drinking period (hours 1-5), the recovery period (hours 6-19), and two control periods corresponding to 24 hours after the drinking and recovery periods. ECGs were analyzed for mean heart rate, atrial tachycardia, premature atrial complexes (PACs), premature ventricular complexes (PVCs), and heart rate variability measures. BAC measurements monitored acute alcohol intake during the drinking period.
Results:
A total of 202 participants were enrolled, of which nine individuals were excluded due to uninterpretable or insufficient ECG recordings. The final cohort comprised 193 participants; the mean age was 29.9 ± 10.6 years, and 70 (36%) were women. None of the participants had a history of cardiac arrhythmias. Regarding chronic alcohol use, based on the 7-day recall method, participants consumed, on average, 6.8 standard drinks per week. The median amount of daily consumed alcohol was 22.9 g/d. The median number of binge drinking sessions during the past 6 months was 5 (interquartile range, 2–12).
During the drinking period, the average number of consumed beverage units were 3.0 ± 2.9 units of beer, 2.1 ± 2.8 units of wine, 4.1 ± 4.0 units of liquor, and 2.0 ± 2.7 units of long drinks. Three-quarters of the participants had ≥2 different types of alcoholic beverages during the drinking period. The average maximum BAC recorded was 1.4 ± 0.4 g/kg, which was similar in men and women.
Increased heart rate and excess atrial tachycardia were associated with increasing alcohol intake. 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 AF and ventricular tachycardias, primarily during the recovery period. Heart rate variation indicated sympathetic activation during alcohol consumption and the recovery period, followed by parasympathetic predominance thereafter.
Conclusions:
The authors conclude that binge drinking is associated with heart rate alterations and increased atrial tachycardias during the drinking period, and the occurrence of clinically relevant arrhythmias during the recovery period, supporting the health concern of holiday heart syndrome.
Perspective:
These data suggest that clinicians are recommended to discuss the risk of arrhythmias among patients who consume alcohol, including younger patients. Although not addressed in this study, the longer-term implications of alcohol use on risk for arrhythmias is of clinical importance. This may be particularly relevant among adults with documented ECG abnormalities exhibited in the short-term, as noted in this study.
Clinical Topics: Arrhythmias and Clinical EP, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias
Keywords: Alcohol Drinking, Arrhythmias, Cardiac, Electrocardiography
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