I'd like to commend David Vinson, MD, and Dustin Ballard, MD, for their article on cold drink heart. (“A Case of Cold Drink Heart.” EMN. 2020;42:13; https://bit.ly/2EM1k7O.)
This just scratched the surface of a clinical entity that we as a specialty have been largely unaware of, as are most cardiologists, apart from a select few electrophysiologists. The issue is known as vagal atrial fibrillation (AF), and is typically found in healthy (often young) endurance athletes with structurally normal hearts and low CHA2DS2-VASc scores.
Episodes of AF are triggered by strong vagal stimuli such as cold drinks, overeating, gastric reflux, etc. In these cases, AF is essentially an escape rhythm, and most often occurs at night while sleeping (remarkably, especially on the left side). Patients who have experience with this have learned to jump out of bed and exercise immediately to reverse or prevent it from occurring when they feel warning palpitations.
Research reveals an entire community of patients suffering from vagal AF for whom prevention and treatment are completely different from those for conventional forms of AF. The precipitants, drug treatments, and even the technique of ablation are different from what would normally be done for conventional AF.
Unfortunately, patients suffering from this are usually faced with primary care physicians, emergency physicians, and even cardiologists who are completely unaware of this syndrome and how to treat it. Given that AF is becoming increasingly common, we as a specialty should be aware of this increasingly common syndrome and how to manage it.
Russ Kino, MD
Santa Monica, CA