Can cold drinks trigger supraventricular tachycardia (SVT)?

Cold Drinks and SVT: No Established Causal Relationship

Cold drinks are not recognized as a trigger for supraventricular tachycardia (SVT) in current clinical guidelines or evidence-based literature. The major cardiology societies do not list cold beverages as a precipitating factor for SVT episodes.

Recognized Triggers for SVT

The established triggers and precipitating factors for SVT are well-documented and do not include cold drinks:

Common Provocative Factors

• Exertion, coffee, tea, and alcohol are the documented beverage-related triggers that may provoke AVNRT 1
• Stimulants and caffeine (referring to caffeinated beverages in general, not temperature) are listed among substances that can trigger SVT 2
• Acute precipitating events including major surgery, pneumonia, and acute myocardial infarction 2

Underlying Conditions That Predispose to SVT

• Structural heart disease, including heart failure, hypertension, and valvular disease 2
• Metabolic disorders such as hyperthyroidism and electrolyte abnormalities 2
• Chronic conditions including chronic lung disease 2
• Congenital heart disease, particularly Ebstein anomaly, Tetralogy of Fallot, and atrial septal defects 2

The Cold Stimulus Paradox

Interestingly, cold stimulation is actually used therapeutically to terminate SVT, not trigger it:

• The "diving reflex" vagal maneuver involves applying an ice-cold, wet towel to the face to stop SVT episodes 1
• Facial immersion in water at 10°C (50°F) has proven effective in terminating tachycardia in laboratory settings 1
• This cold-induced vagal stimulation is a recommended first-line intervention for acute SVT management 1

Clinical Implications

If a patient reports palpitations after consuming cold drinks, consider alternative explanations:

• The caffeine content in cold caffeinated beverages (iced coffee, energy drinks, iced tea) is the likely culprit, not the temperature 1, 2
• Anxiety or heightened awareness of normal sinus tachycardia may be misattributed to the cold drink 1
• True SVT requires documentation on ECG during symptoms, as diagnosis is often delayed due to misdiagnosis of anxiety or panic disorder 3, 4

Diagnostic Approach

• Obtain a 12-lead ECG during tachycardia episodes to confirm SVT 1
• Use Holter monitoring or event recorders if symptoms are episodic 3, 4, 5
• Evaluate for the actual recognized triggers: caffeine content, alcohol, exertion, and underlying cardiac or metabolic conditions 1, 2