Study details

For the study, researchers surveyed 101 individuals who reported experiencing Afib or atrial flutter triggered by cold foods or drinks, a pattern referred to as "cold drink heart," or CDH.

Participants included 39 patients from Kaiser Permanente Northern California EDs and 62 individuals who independently contacted the research team after learning of earlier publications on the topic.

Roughly half of respondents (51.5%) said their Afib episodes occurred only after ingesting cold foods or drinks. Among that group, avoiding cold foods and drinks eliminated their episodes entirely. Across all participants, 86.4% reported that cold avoidance — or modifications such as not using straws, letting beverages warm to room temperature, or sipping slower — reduced or prevented episodes.

Most respondents reported feeling symptoms within seconds to minutes of consuming something cold, and 36.5% said episodes were more likely to occur after physical activity.

"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 Kaiser Permanente physician and senior author David Vinson. "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."

Commentary

One of the study's most notable findings may not be clinical, but cultural. More than half (52.4%) of respondents who discussed CDH with a healthcare provider said they were met with skepticism or outright dismissal.

"We did this study because for decades there have been people telling their healthcare providers that cold foods and drinks trigger their atrial fibrillation episodes -- but many providers have dismissed this possibility," Vinson said in a press release.

Daniel DiLena, a research assistant with the Kaiser Permanente Clinical Research on Emergency Services & Treatments Network and first author of the paper, aligned on Vinson's view.

"Until now, most of the published papers on this topic have been case reports," he said. "Our study provides additional support for the existence of this trigger and hopefully helps validate those with similar experiences and increase awareness among health care providers."

The study also builds on increasing recognition of nontraditional Afib triggers. Alcohol, for example, is known to trigger Afib, but usually after a delay of three to twelve hours. CDH, by contrast, can precipitate symptoms within seconds to minutes.

"[T]he more patients with atrial fibrillation are asked about — or read about — this trigger," Vinson said, "the more often we hear, 'Yes, that's happening to me, too.'"