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. 2025 Aug;36(8):1895-1902.
doi: 10.1111/jce.16753. Epub 2025 Jun 12.

Characterizing Patients With Cold Drink-Triggered Atrial Fibrillation

Daniel D DiLena  1 , Jennifer Y Zhang  1   2 , Adina S Rauchwerger  1 , Mary E Reed  1 , Gregory M Marcus  3 , E Margaret Warton  1 , David R Vinson  1   4   5 ; Kaiser Permanente CREST Network
Affiliations

Characterizing Patients With Cold Drink-Triggered Atrial Fibrillation

Daniel D DiLena et al. J Cardiovasc Electrophysiol. 2025 Aug.

Abstract

Introduction: Atrial fibrillation (AF) is a common arrhythmia with significant health implications. Identifying modifiable lifestyle triggers is important in mitigating recurrence and improving patient outcomes. A subset of AF patients has reported cold drinks or foods as triggers, a phenomenon termed "cold drink heart" (CDH). Literature on CDH is scarce and primarily limited to case studies. We sought to characterize patient experiences with CDH and assess the effectiveness of cold trigger avoidance in reducing AF recurrence among affected patients.

Methods and results: This was a mixed methods study employing a patient survey enhanced by chart review among patients who self-reported CDH. Participants were recruited during emergency department visits for AF or by contacting the principal investigator directly. The survey addressed demographics and clinical features. We compared those with CDH only and those with both CDH and non-CDH AF episodes. The cohort included 101 respondents (75% male). Median age of CDH onset was 44.5 years. More than half of respondents (51.5%) reported that their AF episodes occurred only following cold drink or food consumption. Rapid onset after ingestion was common, and many reported an association with recent physical exertion. Avoidance of cold ingestion was effective in reducing or eliminating AF episodes in 86.4% of cases, with greater success in CDH-only patients (100.0%). Physician awareness was low, with 52.4% of respondents reporting dismissive attitudes from one or more healthcare providers.

Conclusion: CDH is poorly understood and has significant implications for AF prevention. Avoidance strategies may be highly effective, especially for CDH-only patients. Further research is needed to validate these findings and increase provider awareness.

Keywords: atrial fibrillation; atrial flutter; cold drink heart; trigger avoidance; vagal stimulation.

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References

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