title: A Heart too Drunk to Drive; AV Block following Acute Alcohol Intoxication.
abstract: Acute excessive alcohol consumption is associated with heart rhythm disorders like atrial fibrillation but also premature ventricular contractions, collectively known as the "holiday heart syndrome". More rarely but clinically significant are reports of atrioventricular (AV) conduction disturbances in binge drinkers with no underlying heart disease or chronic alcohol consumption. To obtain better insights into common denominators and the potential underlying mechanisms we collected and compared individual case reports of AV block following acute alcohol intoxication in otherwise healthy people. By screening PubMed, Google Scholar, Scopus and JSTOR, fifteen cases were found of which eight were sufficiently documented for full analysis. Blood alcohol levels ranged from 90 to 958 mg/dl (19 to 205 mM). Second and third degree AV block was observed most (6/8) albeit that in two of these patients a vagal stimulus led to deterioration from first into higher order AV block. In all cases, patients reverted to normal sinus rhythm upon becoming sober again. Mildly lowered body temperature (35.9 ± 0.5°C) was observed but can be excluded as a major cause of conduction blockade. We hypothesize that ethanol induced partial inhibition of calcium and potentially also sodium currents in conductive tissue structures may be one of the mechanisms of conduction slowing and block that may become exaggerated upon increased vagal tone. An impairment of gap junction function cannot be excluded as a contributing factor. In conclusion, cases of documented alcohol induced AV block are very rare but events can occur at relatively low serum alcohol levels which should prompt to awareness of this phenomenon in alcohol intoxicated patients.
authors.affiliation: Participant in the Honours Program CRU2006 Bachelor, University Medical Center Utrecht, Heidelberglaan 100, 3584 CM, Utrecht, The Netherlands.
authors.forename: Arthur H
authors.initials: AH
authors.lastname: van Stigt
authors.affiliation: Participant in the Honours Program CRU2006 Bachelor, University Medical Center Utrecht, Heidelberglaan 100, 3584 CM, Utrecht, The Netherlands.
authors.forename: Ruben J
authors.initials: RJ
authors.lastname: Overduin
authors.affiliation: Participant in the Honours Program CRU2006 Bachelor, University Medical Center Utrecht, Heidelberglaan 100, 3584 CM, Utrecht, The Netherlands.
authors.forename: Liza C
authors.initials: LC
authors.lastname: Staats
authors.affiliation: Participant in the Honours Program CRU2006 Bachelor, University Medical Center Utrecht, Heidelberglaan 100, 3584 CM, Utrecht, The Netherlands.
authors.forename: Vera
authors.initials: V
authors.lastname: Loen
authors.affiliation: Department of Medical Physiology, Division of Heart & Lungs, University Medical Center Utrecht, Yalelaan 50, 3584 CM Utrecht, The Netherlands.
authors.forename: Marcel A G
authors.initials: MA
authors.lastname: van der Heyden
mesh_terms: D000208:Acute Disease; D000435:Alcoholic Intoxication / Q000150:complications*; D054537:Atrioventricular Block / Q000209:etiology*; D004562:Electrocardiography / Q000187:drug effects; D000431:Ethanol / Q000633:toxicity; D017629:Gap Junctions / Q000187:drug effects / Q000502:physiology; D006801:Humans; D007473:Ion Channels / Q000187:drug effects / Q000502:physiology
chemical_list: D007473:Ion Channels; D000431:Ethanol