No guzzling, no gulping! How a cold drink or treat on a hot day may trigger AF in those at risk

Avoiding cold drinks and frozen treats could help people at risk for atrial fibrillation (AF) prevent a recurrent episode, a new study suggests.The phenomenon of “cold drink heart” has been described previously, but mostly in case studies. In this study, researchers interviewed and performed a chart review of 101 adults who visited an emergency department in the U.S. for AF or contacted the researchers directly. More than half reported that their AF episode occurred soon after a cold drink or cold food, with 36% saying they had the cold drink or food after some sort of physical exertion.Atrial fibrillation episodes were reduced or eliminated in 86.4% of patients when they avoided cold drinks or cold food.“Although the majority of the people we surveyed said their atrial fibrillation was associated with cold ingestion, it was actually rare that eating or drinking something cold always precipitated an atrial fibrillation episode,” said Dr. David Vinson, senior author of the paper and an emergency physician at the Kaiser Permanente medical centres in Roseville and Sacramento in California. “In other words, most people with cold drink heart were often able to eat cold food or drinks without developing symptoms of atrial fibrillation. This shows how unpredictable the condition can be and why it’s been hard for some patients to identify these triggers.”The cold triggers identified most frequently by patients were ice water, smoothies, milk, yogurt and ice cream.Dr. Peter Lin, a family physician in Toronto, spoke to CBC radio about the science behind cold drink heart. “The esophagus runs right behind your heart, so very cold stuff could irritate the electrical system in the heart and therefore trigger atrial fibrillation,” he explained when asked to comment on the study.“Basically, they’re saying not to guzzle cold drinks, especially after exerting yourself.” Patients at risk for AF could also leave cold food or liquids in their mouth longer before swallowing so it’s warmer when it goes down the esophagus. Dr. Lin pointed out that other triggers for AF episodes include when people susceptible to AF consume alcohol or have a high fever.The study participants were younger than most patients with AF. A total of 75% of the respondents were men, with an average age of 44.5. The cold drink could be a strong enough trigger to unmask younger patients who would have developed AF later in life, Dr. Lin suggested.The majority of the patients said they had previously told a healthcare professional about the connection between cold drinks and an AF episode, but in half the cases, they healthcare professional had dismissed it.“We did this study because for decades there have been people telling their health care providers that cold foods and drinks trigger their atrial fibrillation episodes—but many providers have dismissed this possibility,” said Dr. Vinson in a Kaiser Permanente press release.Dr. Vinson wrote about the phenomenon in the past, both in a 2016 case study and an essay in a Kaiser Permanente publication. He urges physicians to take it seriously. “By not recognizing the triggering capacity of ingesting cold stimuli, many physicians are missing the chance to collaborate with their patients in symptom management,” he wrote in the 2020 essay. The latest study was published in the Journal of Cardiovascular Electrophysiology.

No guzzling, no gulping! How a cold drink or treat on a hot day may trigger AF in those at risk

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