There is a well known association between alcohol consumption and rhythm disturbances, particulary if the alcohol intake is large or unusual for the person. The development of supraventricular tachyarrhythmias in apparently normal people is called "holiday heart syndrome". The syndrome was first described in persons with heavy alcohol consumption, who typically presented to emergency rooms on weekends or after holidays, but it may also occur in patients who drink little or no alcohol. The most common rhythm disorder is atrial fibrillation, which usually converts to normal sinus rhythm within 24 hours without any treatment. The diagnosis of holiday heart syndrome should be considered when patients without any overt cardiac disease present with new onset atrial fibrillation. Though recurrences can occur, the clinical course is usually benign and specific therapy is usually not warranted. The exact nature of how alcohol induces Af is not well understood but many reseachers believe that multiple pathways alter atrial automaticity. Two of the most plausable theories are 1) direct chemical irritation of the atria by alcohol, and 2) dehydration / electrolyte depletion. Patients should be given O2, monitored and an IV are appropriate. Often these patients are dehydrated from the diuretic effect of alcohol. Giving 500 cc of saline is not an unusual treatment in this case (contact your medical control) don't expect fluids to suddenly convert your patient. Time seems to be the best treatment. Checking the patient's blood sugar is also appropriate care. REMEMBER that Adenosine is contraindicated as a treatment for atrial fibrillation or flutter because it offers no chance for success but exposes the patient to all the potential risks of IV medications. In the rare case of very rapid Af and hemodynamic compromise, you may have to use a calcium ch blocker or synchronized cardioversion.
Updated: August 6, 1999