Holiday Heart Syndrome

Scenario: A 53-year-old male arrived at the mentally ill/chemically addicted unit with acute alcohol withdrawal. His electrocardiogram (ECG) showed the cardiac rhythm below. The patient was a recovering alcoholic but a week earlier had left his family and checked into a motel to drink alcohol. He had stopped eating and had been drinking continuously when he noticed chest palpitations and shortness of breath the day before Thanksgiving. However, he delayed going to the hospital until after Thanksgiving because he wanted to watch the football games. Before the diagnosis of alcoholism 2 years earlier, the business executive had no medical issues; in fact, he had been very healthy and had run marathons.The cardiac rhythm is atrial fibrillation at 84/min. The ECG strip carries an “EASI” label indicating that the monitoring system is using 5 electrodes in a unique configuration to derive continuous 12-lead ECG data. The 2 leads displayed are leads II and V2. Alcohol induced atrial arrhythmias, most commonly atrial fibrillation, are also referred to as holiday heart syndrome.Consuming massive quantities of alcohol, especially in the absence of nutrition, results in severe metabolic and electrolyte disturbances. Therefore, before electrical cardioversion was considered, the cardiac team normalized the patient’s blood chemistry to provide the opportunity for spontaneous conversion to normal sinus rhythm.Treatment included intravenous diltiazem, which controlled the ventricular rate. However, the arrhythmia failed to spontaneously convert after 4 days of alcohol detoxification therapy. A transesophageal echocardiogram revealed no apical mural thrombi, so a synchronized cardioversion shock was delivered without complication resulting in successful conversion to sinus rhythm (see ECG strip below).Overall, there are fewer complications from atrial fibrillation among alcoholic patients than among nonalcoholics, and most (90%) convert spontaneously to a normal sinus rhythm with proper medical management. A careful clinical history, to include alcohol use and misuse, should be considered early as the differential diagnosis of new-onset atrial fibrillation in younger patients.