The “Holiday Heart” is an old concept to describe the connection between alcohol and atrial fibrillation. It stems from an older American study from 1979. The study observed that atrial fibrillation was far more frequent in vacationing Americans with a very high alcohol consumption, so those who channeled the spirit of the Mad Men TV Show.
It is important to understand the difference between alcohol as a risk factor for developing atrial fibrillation and alcohol as a risk factor for relapse of atrial fibrillation once you have had one – or more – episodes.
Study on atrial fibrillation and alcohol consumption
In 2014, a Swedish researcher published a large study of the connection between alcohol consumption and the risk of developing atrial fibrillation. 70,000 Swedes were examined, of which approximately 6,000 developed atrial fibrillation during the period of the study. At the same time the team conducted a meta-analysis of previous studies from around the world.
In the Swedish study, it was found that alcohol is a risk factor for developing atrial fibrillation – and the greater the alcohol intake, the greater the risk. However, the correlation was only statistically significant with an alcohol intake of more than 2 drinks per day (without the distinction between men and women). With an average intake of 2-3 drinks per day, the risk of atrial fibrillation increases by 14% compared to an intake of less than 1 drink per week. Someone who drinks more than 3 drinks per day increases their risk by 39%. As the average lifetime risk of developing atrial fibrillation is approximately 25%, the lifetime risk increases to around 28% at an average alcohol intake of 2-3 drinks per day.
Copenhagen Heart Studies
Overall, there is no doubt that there is some link between alcohol consumption and the risk of developing atrial fibrillation. However, the connection is relatively weak and does not give reason to advise against alcohol intake beyond the restrictions already recommended by the national health authorities as the maximum intake for women and men, respectively.
What if a patient already has atrial fibrillation? Here the scientific evidence is less compelling and the subject is very poorly studied.
This means I need to lean on my own experience and observations. I have no doubt that in some patients with atrial fibrillation there is a clear link between alcohol intake and episodes of fibrillation. Most often as a flicker in the evening, and often after just a glass of wine or two.
However I also have no doubt that these patients are a minority. For most patients there is no obvious connection between moderate alcohol consumption and episodes of flicker. Direct studies on the effect of alcohol on heart muscle cells and the nerve supply to the heart have shown both positive and negative effects. On the other hand, there is no doubt that excessive intake of alcohol (“binge drinking”) may provoke atrial fibrillation – and especially in persons already experiencing seizures of atrial fibrillation.
My Recommendations On Alcohol Consumption:
If you have noticed that alcohol is an exacerbating factor – then you should abstain. If, on the other hand, it is not obvious that alcohol provokes atrial fibrillation in you, there is no reason to refrain from (moderate) alcohol consumption. Nor is there any reason why your doctor or others should advise you against taking a glass of wine every now and then.
If in doubt, ask yourself how many times you have had a certain alcohol intake WITHOUT feeling negative effects on your heart rhythm? Since a smaller, but frequent, alcohol consumption is very common among adults, there will be a good chance that a suspected connection is just a coincidence.
As a rule of thumb:
- If you drink a glass of wine daily and get atrial fibrillation a few times a month, there is probably no connection
- If you drink a glass of wine once every three weeks and experience episodes of atrial fibrillation afterwards, then there is a probable connection.