Journal
INTERNATIONAL JOURNAL OF CARDIOLOGY
Volume 331, Issue -, Pages 100-105Publisher
ELSEVIER IRELAND LTD
DOI: 10.1016/j.ijcard.2021.01.071
Keywords
Atrial fibrillation; Alcohol; Binge drinking; Hangover; Premature atrial contraction
Categories
Funding
- National Heart Foundation of Australia Early Career Fellowship
- NHMRC practitioner fellowship
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The study suggests that binge drinking leads to sympathetic activation followed by a 'rebound' parasympathetic response and atrial mechanical dysfunction, which may explain the propensity and temporal association between binge drinking and atrial fibrillation.
Background: Binge drinking is a common atrial fibrillation (AF) trigger, however the mechanisms are poorly understood. Objective: To investigate the effects of alcohol intoxication and hangover with rhythm monitoring and cardiac MRI. Methods: Patients underwent serial cardiac MRI pre- and post-binge with continuous Holter monitoring. Time periods analyzed: baseline (24 h pre-binge), consumption, hangover (0- 24 h post-consumption) and post-hangover (24-48 h post-consumption). Results: 50 patients (age 49 +/- 15 years, 40% paroxysmal AF) completed the study (intake 8.4 +/- 3.1 standard drinks). Mean heart rate increased from 72 +/- 10 to 80 +/- 13 beats per minute (bpm) during consumption (p < 0.001). The hangover period was characterised by higher daily atrial ectopic count (50, IQR 10-132 vs baseline 43, IQR 10-113: p = 0.04) and reduced heart rate variability (SDNN 55 ms, IQR 40-65 versus 62 ms, IQR 51-66; p = 0.007). There was evidence of heightened parasympathetic activity post-hangover with heart rate slowing (mean HR 54 +/- 6 bpm; p = 0.03) and increased activity in the High frequency band when separating the complex heart rate variability waveform into its component rhythms (291 ms(2), 97-538 versus baseline 237 ms(2), IQR 104-332; p = 0.04). Three patients developed AF 11, 29 and 34 h post-binge. Cardiac MRI (2.7 +/- 0.7 days post-binge) demonstrated a decrease in left atrial (LA) emptying fraction (57.9 +/- 8.5 to 53.5 +/- 6.7%; p = 0.003) but no change in LA volume, left ventricular ejection fraction or markers of ventricular inflammation. Conclusion: Binge drinking is assodated with sympathetic activation followed by a 'rebound' parasympathetic response and atrial mechanical dysfunction which may explain the propensity and temporal association between binge drinking and AF. (C) 2021 Elsevier B.V. All rights reserved.
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