People Are Swearing Off Cold Drinks to Prevent Afib

People reporting cold drinks or foods as triggers for their atrial fibrillation (Afib) were invited to a survey.Approximately half the cohort reported reducing their Afib episodes by avoiding cold ingestion, with methods including waiting for drinks to warm to room temperature and eliminating straw use.Healthcare providers often held a dismissive attitude towards the so-called “cold drink heart” phenomenon, the study showed.

Avoiding ice water, smoothies, and ice cream seemed to work as a lifestyle change for some with atrial fibrillation (Afib or AF), according to the first cross-sectional survey of people with “cold drink heart” (CDH).

Among people who claimed to have ever had symptomatic Afib triggered by cold ingestion, 51.5% reported that their Afib episodes occurred only following cold drink or food consumption (as opposed to other triggers). In these patients, avoidance of cold ingestion reduced or eliminated their Afib episodes with 100% effectiveness (as opposed to 72.4% in people who also had a history of non-CDH Afib).

“When asked about avoidance, respondents reported several effective behavioral modifications in lieu of complete avoidance, such as reducing speed of ingestion or avoiding rapid gulping, eliminating straw use, allowing drinks to warm to room temperature, or warming liquids in their mouth before swallowing,” reported David Vinson, MD, of Kaiser Permanente (KP) Northern California in Pleasanton, and colleagues in the Journal of Cardiovascular Electrophysiology.

With their survey, the investigators had taken the first step to study the cold drink-Afib link more systematically, beyond the initial case reports.

The survey included 101 people who self-reported cold ingestion-triggered symptomatic Afib or atrial flutter at KP Northern California emergency departments (n=39) and an additional cohort of non-KP patients who had contacted the research team, unsolicited, offering their experience with CDH (n=62).

“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,” said Vinson in a press release. “Yet, the more patients with atrial fibrillation are asked about — or read about — this trigger, the more often we hear, ‘Yes, that’s happening to me, too.'”

“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,” Vinson noted. “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.”

He and his study co-authors urged greater clinician awareness of CDH in the setting of Afib, citing one estimate that 5-10% of people with paroxysmal Afib may have cold drinks or foods as a trigger.

In their present report, patients said they had gotten a range of reactions from professionals when they shared their experiences: 52.4% of respondents reported dismissive attitudes from one or more healthcare providers, while some actually said they learned about the phenomenon from a physician.

In practice and in research, alcohol is more established as a dietary trigger of Afib.

“Alcohol ingestion has been recently identified as a trigger of discrete AF events, but only after a delay of 3-12 [hours]. This hours‐long delay contrasts with the relative immediacy of cold drink triggers, which precipitate AF within seconds to minutes,” wrote Vinson’s group.

Vinson and colleagues recruited a study cohort that was 75% men with a median age of 56 years, a median CHA₂DS₂‐VASc score of 1, and 25.7% on anticoagulants. Patients said they had been 44.5 years old at CDH onset.

When asked which rhythm was triggered by cold ingestion, 74.3% of patients reported only Afib, 15.8% said both Afib and flutter, 3.0% flutter only, while 7.0% said they were unsure.

The KP cohort underwent chart review for ECG confirmation of their Afib. As for the outside cohort, a documented diagnosis of AF or atrial flutter was required but these patients did not have to share their medical records.

Study authors noted that 36.5% of those surveyed reported that Afib was often triggered by cold ingestion soon after physical activity, and some reported that this was always the case for their CDH episodes.

“While the underlying mechanism could not be elucidated by the current study, an exacerbation after exercise suggests a vagotonic effect. Indeed, heightened vagal tone appears to trigger AF, and esophageal stimulation such as with a cold drink, may acutely increase such an autonomic response,” Vinson’s group surmised.

“Alternatively, as the esophagus lies directly behind and often in contact with the posterior left atrium, direct cold mechanical irritation of the left atrium may also be responsible, which also could be exacerbated post-exercise due to the relative increase in vagal tone,” the investigators continued.

Rapid gulping or swallowing was reportedly also more likely to provoke Afib, the survey found.

Vinson and colleagues acknowledged that the study was not designed to prove causality and that the survey responses may have been inaccurate. There was likely some degree of selection bias affecting the study, as well.

“Further study will be required to assess the prevalence of CDH among an unselected population of AF patients, and importantly, the generalizability of our findings around the effectiveness of cold drink avoidance and other behavioral modifications in reducing AF recurrence,” they wrote.

Disclosures

The study was supported by The Permanente Medical Group Delivery Science and Applied Research program.

Vinson had no personal disclosures.

One study co-author reported funding from the NIH and PCORI and personal ties to InCarda.

Primary Source

Journal of Cardiovascular Electrophysiology

Source Reference: DiLena DD, et al “Characterizing patients with cold drink-triggered atrial fibrillation” J Cardiovasc Electrophysiol 2025; DOI: 10.1111/jce.16753.