Holiday Heart Syndrome Treatment & Management

Updated: Aug 31, 2017
  • Author: Adam S Budzikowski, MD, PhD, FHRS; Chief Editor: Jose M Dizon, MD  more...
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Medical Care

Patients presenting to the emergency department with sustained tachyarrhythmia secondary to acute alcohol toxicity usually can be observed with electrocardiographic monitoring. Treatment with an atrioventricular nodal blocking agent (eg, beta-blocker, verapamil, diltiazem) may be needed if the ventricular rate is excessive. If the duration of atrial fibrillation approaches 24-48 hours, cardioversion should be considered to obviate the need for anticoagulation. In general, pericardioversion anticoagulation is required for atrial fibrillation lasting more than 48 hours.

Most patients with structural heart disease should be admitted for observation and treatment if the arrhythmia persists.

Young patients with no evidence of structural heart disease sometimes can be discharged without further treatment once their arrhythmia has stabilized.

Upon resolution of holiday heart symptoms and return to sinus rhythm, treadmill stress testing is reasonable in some patients to look for exercise-related arrhythmia when the acute effects of alcohol have resolved. This is also important in patients at risk for coronary artery disease; occasionally, additional cardiac imaging (eg, perfusion imaging, echocardiography) is required.

Advise all patients against the excessive use of alcohol in the future, to refrain from stimulants, and to avoid excessive fatigue. The appearance of atrial fibrillation in patients in whom it is otherwise unexpected (for example, college students) should prompt a discussion of alcohol consumption and the possible cardiac and noncardiac consequences. Persons with alcoholism should be considered for transfer to facilities for detoxification/rehabilitation. 

Alcohol-induced atrial fibrillation without other unrelated episodes would not typically be considered a current indication for atrial fibrillation surgical or catheter ablation.


Patients presenting with new-onset tachyarrhythmias and structural heart disease, such as myocardial ischemia and/or left ventricular dysfunction, often require a more extensive evaluation, and consultation with a cardiologist may be necessary.


Diet and Activity


The use of alcohol is contraindicated. Stimulants such as caffeine should be avoided initially; the interaction of alcohol and caffeine on atrial fibrillation has not been determined.


Following alcohol-related arrhythmia, it usually is advisable for patients to refrain from significant exertion because excessive catecholamines can precipitate recurrent episodes in some cases. Most patients without underlying heart disease should be able to gradually resume full physical activity over the next few days.