Aleksandr Voskoboinik1, Conor McDonald2, David Chieng3, Jessica O'Brien2, Sarah Gutman2, Phillip Ngu2, Hariharan Sugumar1, Geoffrey Wong4, Jonathan M Kalman5, Andrew J Taylor6, Peter M Kistler7. 1. Heart Centre, The Alfred Hospital, Melbourne, Australia; Baker Heart & Diabetes Institute, Melbourne, Australia; Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia. 2. Heart Centre, The Alfred Hospital, Melbourne, Australia. 3. Heart Centre, The Alfred Hospital, Melbourne, Australia; Baker Heart & Diabetes Institute, Melbourne, Australia. 4. Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia. 5. Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia. 6. Heart Centre, The Alfred Hospital, Melbourne, Australia; Baker Heart & Diabetes Institute, Melbourne, Australia; Department of Medicine, Monash University, Melbourne, Australia. 7. Heart Centre, The Alfred Hospital, Melbourne, Australia; Baker Heart & Diabetes Institute, Melbourne, Australia; Department of Cardiology, Cabrini Hospital, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia; Department of Medicine, Monash University, Melbourne, Australia. Electronic address: peter.kistler@baker.edu.au.
Abstract
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 ms2, 97-538 versus baseline 237 ms2, 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 associated 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.
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 ms2, 97-538 versus baseline 237 ms2, 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 associated 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.
Authors: Stefan Brunner; Raphaela Winter; Christina Werzer; Lukas von Stülpnagel; Ina Clasen; Annika Hameder; Andreas Stöver; Matthias Graw; Axel Bauer; Moritz F Sinner Journal: Sci Rep Date: 2021-06-24 Impact factor: 4.379