Heart Centre, The Alfred Hospital, Melbourne, Australia; Baker Heart & Diabetes Institute, Melbourne, Australia; Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia.
Heart Centre, The Alfred Hospital, Melbourne, Australia.
Int J Cardiol. 2021 May 15;331:100-105. doi: 10.1016/j.ijcard.2021.01.071. Epub 2021 Feb 3.
Binge drinking is a common atrial fibrillation (AF) trigger, however the mechanisms are poorly understood.
To investigate the effects of alcohol intoxication and hangover with rhythm monitoring and cardiac MRI.
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).
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, 97-538 versus baseline 237 ms, 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.
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.
binge drinking 是心房颤动（AF）的常见诱因，但机制尚不清楚。
通过心律监测和心脏 MRI 研究酒精中毒和宿醉的影响。
患者在 binge 前后进行了一系列心脏 MRI 检查，并进行了连续的 Holter 监测。分析的时间段：基线（ binge 前 24 小时）、饮酒期、宿醉期（饮酒后 0-24 小时）和宿醉后（饮酒后 24-48 小时）。
50 名患者（年龄 49±15 岁，40%为阵发性 AF）完成了研究（摄入 8.4±3.1 标准饮品）。饮酒期间，平均心率从 72±10 次/分钟增加到 80±13 次/分钟（p<0.001）。宿醉期表现为每日房性异位搏动计数增加（50，IQR 10-132 与基线 43，IQR 10-113；p=0.04）和心率变异性降低（SDNN 55ms，IQR 40-65 与 62ms，IQR 51-66；p=0.007）。宿醉后有证据表明副交感神经活动增强，心率减慢（平均心率 54±6bpm；p=0.03），当将复杂的心率变异性波形分解为其组成节律时，高频带活动增加（291ms，97-538 与基线 237ms，IQR 104-332；p=0.04）。三名患者在 binge 后 11、29 和 34 小时发生 AF。心脏 MRI（ binge 后 2.7±0.7 天）显示左心房排空分数降低（57.9±8.5 至 53.5±6.7%；p=0.003），但左心房容积、左心室射血分数或心室炎症标志物无变化。
binge drinking 与交感神经激活后“反弹”副交感神经反应以及心房机械功能障碍有关，这可能解释了 binge drinking 与 AF 之间的倾向性和时间关联。
