Atrial Fibrillation in Healthy Adolescents after Highly Caffeinated Beverage Consumption

Two Case Reports

Jennifer R Di Rocco; Adelaide During; Peter J Morelli; Marybeth Heyden; Thomas A Biancaniello

Disclosures

J Med Case Reports. 2011;5(1) 

In This Article

Abstract and Introduction

Abstract

Introduction: Energy drinks and highly caffeinated drinks comprise some of the fastest growing products of the beverage industry, often targeting teenagers and young adults. Cardiac arrhythmias in children related to high caffeine consumption have not been well described in the literature. This case series describes the possible association between the consumption of highly caffeinated drinks and the subsequent development of atrial fibrillation in the adolescent population.
Case presentations: We report the cases of two Caucasian adolescent boys of 14 and 16 years of age at the time of presentation, each without a significant cardiac history, who presented with palpitations or vague chest discomfort or both after a recent history of excessive caffeine consumption. Both were found to have atrial fibrillation on electrocardiogram; one patient required digoxin to restore a normal sinus rhythm, and the other self-converted after intravenous fluid administration.
Conclusion: With the increasing popularity of energy drinks in the pediatric and adolescent population, physicians should be aware of the arrhythmogenic potential associated with highly caffeinated beverage consumption. It is important for pediatricians to understand the lack of regulation in the caffeine content and other ingredients of these high-energy beverages and their complications so that parents and children can be educated about the risk of cardiac arrhythmias with excessive energy drink consumption.

Introduction

Atrial fibrillation is extremely rare in the pediatric population, almost always occurring in association with structural heart disease, such as rheumatic mitral valve disease, congenital heart disease with dilated atria, and rarely, as a complication of intra-atrial surgery.[1] Patients may present with palpitations, dyspnea, fatigue, light-headedness, or syncope. The electrocardiogram is characterized by disorganized atrial activity without discrete P waves. The ventricular response is often irregularly irregular. Without a prior cardiac or family history, other inciting causes such as thyrotoxicosis, infectious pericarditis, and pulmonary emboli should be considered in the previously healthy child presenting with new-onset atrial fibrillation.[2]

Exogenous causes of atrial fibrillation through a substrate such as caffeine have not been widely reported in the literature, especially in the pediatric population. A large-scale Danish study evaluating adult human caffeine consumption and arrhythmias did not find a higher risk of atrial fibrillation or flutter with variable oral consumption of caffeine from everyday sources.[3] A controlled trial of escalating doses of caffeine in dogs surprisingly found that serum caffeine actually decreased the propensity for atrial fibrillation;[4] another canine trial demonstrated an increase in cardiac arrhythmias with high doses of caffeine administered.[5] A recent case report outlined a correlation between prolonged inhaled salbutamol and concurrent chocolate abuse, leading to an atrial arrhythmia in an adult, postulating that the caffeine in the chocolate coupled with the short-acting beta agonist triggered the arrhythmia.[6] Another case report described a 58-year-old man with atrial fibrillation and a dilated cardiomyopathy, which resolved when he discontinued his excessive caffeine consumption.[7]

Caffeine is a natural stimulant found in tea leaves, coffee beans, and cacao, and is one of the most popular psychoactive substances used today. Caffeine causes central and peripheral nervous system stimulation through antagonism of adenosine receptors and also has dopaminergic properties, which lend to its addictive potential.[8] The half-life of caffeine in a normal healthy adult is estimated to be from 2.5 to 10 hours, depending on the individual. Long-term consumption of caffeine or consumption of large amounts of caffeine will prolong its half-life.[9,10] The US Food and Drug Administration deems, "caffeine is generally recognized as safe when used in cola-type beverages up to a level of 0.02 percent".[11] The population as a whole has variable sensitivity to the stimulant effects of caffeine; one's tolerance and dependence on caffeine seem to be somewhat heritable and may be linked to genetic polymorphisms.[8] The physiologic and psychological effects of caffeine have been studied in adults but have not been systematically analyzed in children.[8]

Energy drinks and highly caffeinated drinks comprise some of the fastest-growing products of the beverage industry, often targeting teenagers and young adults.[8,12] This case series describes the possible association between the consumption of highly caffeinated drinks and the development of cardiac arrhythmias, specifically atrial fibrillation, in the adolescent population. We report two cases of atrial fibrillation in healthy adolescent boys after the consumption of energy drinks.

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