Timeline of Irregular Heartbeats Emerges From Close Watch of Young Binge Drinkers

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Alcohol-related increase in PVCs suggests more attention to ventricular arrhythmias

by
Nicole Lou, Senior Staff Writer, MedPage Today
October 4, 2024

Continuous rhythm monitoring showed the timeline in which heart rate and atrial tachycardias typically arise after binge drinking by young adults, researchers reported.

In people with no known history of cardiac arrhythmias, premature ventricular complexes (PVCs) were more frequent during the hours of alcohol consumption, after which premature atrial complexes occurred significantly more frequently about a day later, according to a group led by Stefan Brunner, MD, of LMU Klinikum University Hospital of the Ludwig-Maximilians-Universität in Munich, Germany.

Also, during the hours of recovery after binge drinking, some of the roughly 200 participants experienced notable arrhythmic episodes, including atrial fibrillation (Afib; n=1), non-sustained ventricular tachycardias (n=2), and various degrees of atrioventricular block (n=4), the MunichBREW II study group reported in the European Heart Journal.

“Taken together, the ‘Holiday Heart Syndrome’ remains rare in otherwise healthy individuals, but should be recognized as a relevant health problem,” Brunner’s group concluded.

They noted that a heart rate variability analysis indicated autonomic modulation, with sympathetic activation during and soon after alcohol consumption, followed by parasympathetic predominance thereafter.

Prior research has shown that beyond the excessive drinking linked to “Holiday Heart,” even small amounts of alcohol can be linked with incident Afib. Alcohol is among the substances associated with early-onset atherosclerotic cardiovascular disease, especially in women.

“Whereas the ‘Holiday Heart Syndrome’ is typically linked with atrial fibrillation, also cases of malignant ventricular arrhythmias and sudden cardiac death have been reported. Given the alcohol-related increase in PVCs and as ventricular ectopy may eventually deteriorate to ventricular tachycardia, the relation of excessive alcohol intake and ventricular arrhythmias may have been underestimated,” Brunner and colleagues suggested of the prior literature.

They cited their original MunichBREW cross-sectional study that showed a significant association between breath alcohol concentration (BAC) and cardiac arrhythmias, and a 0.59% incidence of new-onset Afib among Munich Octoberfest participants in 2015. That study had lacked continuous rhythm monitoring that could capture delayed arrhythmias, however.

MunichBREW II was a single-arm study that enrolled people from 2016 to 2017.

Participants were 202 adult volunteers planning acute alcohol consumption with expected peak BACs of ≥1.2 g/kg. Investigators excluded individuals with a known history of Afib, a cardiac implantable electronic device, or contraindications to the study procedure.

As part of the study, people agreed to 48-hour electrocardiographic monitoring with a patch Holter recorder. They subsequently drank in public or private locations accompanied by study personnel. A handheld breathalyzer provided BAC measurements to assess acute alcohol intake.

According to Brunner’s group, the final study cohort included 193 people (mean age 29.9 years, 36% women) who had sufficient ECG recordings. Their chronic alcohol use came out to an average 6.8 drinks per week, and there was a median 22.9 g of daily consumed alcohol.

During the recorded drinking sessions, the average maximum BAC reached was 1.4 g/kg in both men and women.

Long-term follow-up conducted in 2024 revealed a very high burden of symptomatic events (e.g., palpitations) self-reported by over 20% of participants. There were two additional cases of clinically diagnosed Afib from that long-term follow-up, averaging 7.2 years.

The authors nevertheless acknowledged the study’s limited generalizability to older individuals, those with preexisting heart disease, and the general population. The investigators also did not look for relevant arrhythmias that may have arisen beyond the initial 48-hour observation period.

“Given the still low numbers and the long observation period of>7 years, any conclusion needs to be made with caution. Yet, considering a total of three atrial fibrillation diagnoses among our relatively young participants one might infer an association with alcohol consumption,” Brunner and colleagues surmised.