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Ten Additional Cases of Atrial Fibrillation Triggered by the Sequence of Strenuous Exercise and Cold Drink

      We read with great interest the case report by Hughes and Schneir, “Paroxysmal Atrial Fibrillation Associated with the Trigger Sequence of Strenuous Exercise Followed by Cold Water Ingestion,” which describes a trigger sequence for atrial fibrillation that is not well documented in the literature (
      • Hughes G
      • Schneir A.
      Paroxysmal atrial fibrillation associated with the trigger sequence of strenuous exercise followed by cold water ingestion.
      ). The patient, a healthy 64-year-old man with no history of atrial fibrillation, experienced two isolated episodes of atrial fibrillation, both triggered by the specific sequence of strenuous exercise followed by ingestion of cold water. Both episodes of atrial fibrillation resolved with electrical cardioversion. His cardiac evaluation was unremarkable. Over the subsequent seven years, he avoided this particular trigger dyad and had not experienced a recurrence of atrial fibrillation—although he had continued to engage in strenuous exercise without cold drinks and to drink his cold beverages, but not in a post-exertional state. As only the combination threw him into atrial fibrillation, only the combination needed to be avoided to maintain effective rhythm control.
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      References

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        • Schneir A.
        Paroxysmal atrial fibrillation associated with the trigger sequence of strenuous exercise followed by cold water ingestion.
        J Emerg Med. 2022; 62: 390-392
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        Individualized studies of triggers of paroxysmal atrial fibrillation: the I-STOP-AFib randomized clinical trial.
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