Holiday Heart Syndrome (HHS) refers to the sudden onset of atrial fibrillation (AF) or other arrhythmias in people with no known heart disease. It often occurs after excessive alcohol consumption, particularly during holidays or long weekends.

AF is a common and potentially serious arrhythmia. It increases the risk of blood clots, stroke and heart failure. In HHS, it occurs in young or healthy individuals, which can delay diagnosis. The link with alcohol is sometimes misidentified, as the symptoms (palpitations, shortness of breath, general discomfort) can be attributed to other causes.

The diagnosis of this condition is based on an ECG showing recent AF and a medical history revealing significant alcohol consumption in the preceding hours. However, in practice, this syndrome is often underestimated. This is because it can disappear spontaneously in less than 24 hours. As a result, treatment remains unclear, and there are no clear protocols, which means that management varies from one hospital service to another. Finally, little advice is given on abstinence or reducing alcohol consumption, which is still essential to prevent recurrence.

In this context, this study was initiated to investigate the link between alcohol and AF, explaining the mechanisms of HHS, clinical data and clinical management difficulties.

In this study, 11 trials were selected according to the following parameters: cohort studies, case-control studies, and observational trials. These trials focused solely on adult patients with no known cardiovascular disease who had consumed alcohol acutely.

The results are consistent: acute alcohol consumption (particularly ≥5 drinks in 2 hours) is strongly associated with an increased risk of AF, even in the absence of structural heart disease.

The studies report :

• a rapid increase in heart rate and a decrease in heart rate variability (HRV) after excessive consumption;
• sympathetic activation with suppression of vagal tone, promoting atrial ectopy;
• alterations in ion channels, particularly T-type calcium channels, responsible for electrical instability;
• transient mechanical alterations, such as a reduction in left atrial ejection fraction, observed on echocardiography.

Alcohol-induced AF often appears within 24 hours of consumption and regresses spontaneously in most cases after withdrawal, without specific treatment.
Studies also show inter-individual variability, with more frequent cases in young men and athletes, but also an underestimation of risk in elderly patients or those taking multiple medications.

Alcohol-related atrial fibrillation, or ‘Holiday Heart Syndrome’, is an under-recognised condition in individuals with no history of cardiovascular disease. The major challenges lie in identifying at-risk patients, educating them about the dangers of binge drinking, and tailoring recommendations. In this context, this study was initiated to clarify the links between acute alcohol consumption and AF. The data support a direct pro-arrhythmogenic ethanol effect via transient autonomic, electrophysiological and mechanical disturbances.

However, this work has some limitations that restrict generalization and justify further research (heterogeneous studies, self-reported data, etc.). Future studies should be based on large-scale prospective studies, using standardised tools for screening alcohol consumption and ambulatory ECG monitoring, in order to better assess the actual incidence of alcohol-related episodes of atrial fibrillation. It will also be essential to clarify the long-term prognosis for patients with isolated post-alcohol AF, particularly in terms of recurrence and thromboembolic risk. In clinical practice, systematic screening for alcohol consumption should be included in the assessment of acute palpitations and recurrent AF. Finally, raising public awareness of the arrhythmogenic effects of binge drinking appears essential to improve prevention.