Holiday Heart Syndrome Treatment & Management

Updated: May 30, 2018
  • Author: Lawrence Rosenthal, MD, PhD, FACC, FHRS; Chief Editor: Jose M Dizon, MD  more...
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Treatment

Medical Care

Patients presenting to the emergency department with sustained tachyarrhythmia secondary to acute alcohol toxicity usually can be observed with electrocardiographic (ECG) monitoring. The three tenets of atrial fibrillation management are rate control, rhythm control, and stroke prevention. (This is well covered in the Medscape Drugs and Diseases topic Atrial Fibrillation. See also the Guidelines section for guidelines recommendations.)

Given the generally transient nature of alcohol-induced atrial fibrillation in the structurally normal heart, rate control and supportive care for alcohol intoxication is generally adequate. For rate control, treatment with an atrioventricular nodal blocking agent (eg, beta-blocker, calcium channel blocker) may be needed if the ventricular rate is rapid. If the duration of atrial fibrillation approaches 24-48 hours, cardioversion (pharmacologic or electrical) may be considered once the patient is medically optimized and the alcohol withdrawal period is complete. 

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

Advise all patients against the excessive use of alcohol in the future and to refrain from use of stimulants. As discussed under the Pathophysiology and Prognosis sections, there is no "healthy" dose of alcohol for prevention of atrial fibrillation. The appearance of atrial fibrillation in patients in whom it is otherwise unexpected (eg, 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.

Consultations

Initial consultation of a local cardiologist is recommended. Eventually, the patient may also require the clinical care of an electrophysiologist (a specialist in the subspecialty of cardiology focused on electrical disease of the heart).

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Diet and Activity

Diet

The use of alcohol in general is not recommended, specifically regarding risk of atrial fibrillation. As already noted in the Pathophysiology and Prognosis sections, there is no "healthy" dose of alcohol for prevention of atrial fibrillation. However, this should be balanced with the potential overall cardiovascular benefits with limited alcohol use. Intuitively, stimulants such as caffeine and over-the-counter medications should be avoided initially. However, note that caffeine consumption has not been clearly associated with an increased incidence of atrial fibrillation. [33]

Activity

Following alcohol-related arrhythmia, it is usually 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.

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