What is the prognosis of holiday heart syndrome (HHS)?

Updated: May 30, 2018
  • Author: Lawrence Rosenthal, MD, PhD, FACC, FHRS; Chief Editor: Jose M Dizon, MD  more...
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The prognosis of holiday heart syndrome (HHS) depends on the presence of any underlying heart disease. Long-term alcohol use increases the risk of cardiomyopathy, arrhythmia, and chronic liver disease.

Note that although the majority (>90%) of cases of alcohol-related atrial fibrillation self-terminate, approximately 20%-30% will recur within 12 months. [11] When considering the type of atrial fibrillation, moderate to heavy alcohol consumption was the strongest risk factor for progression from paroxysmal atrial fibrillation to persistent atrial fibrillation. [25]


A study showed that males who consume more than 27 standard drinks per week have a higher risk of death, stroke, or systemic thromboembolism. [26] The same study demonstrated that females consuming over 20 standard drinks per week were at a higher risk of stroke or systemic thromboembolism. [26] However, contradictory evidence was seen in another study that demonstrated consumption of greater than 14 standard drinks per week was associated with a lower stroke risk. [3] This highlights the fact that the relationship between atrial fibrillation and thrombogenesis is still not well understood.

Note that the incidence of atrial fibrillation, as a function of alcohol ingestion, clearly increases in a linear and dose-dependent fashion. A separate issue is that modest alcohol consumption has been shown to be beneficial. As such, there is a U-shaped curve relating to alcohol consumption and overall cardiovascular mortality. [3] Stated another way: With the available data, there is no dose of alcohol that should be considered "protective" for atrial fibrillation, whereas there is clearly a range of alcohol dosage that is protective with regard to overall cardiovascular disease. [3]

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