Di Rocco et al. Journal of Medical Case Reports 2011, 5:18 http://www.jmedicalcasereports.com/content/5/1/18 C A S E R E P O R T JOURNAL OF MEDICAL CASE REPORTS Open Access Atrial fibrillation in healthy adolescents after highly caffeinated beverage consumption: two case reports Jennifer R Di Rocco1, Adelaide During2, Peter J Morelli3*, Marybeth Heyden3, Thomas A Biancaniello3 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 popu- lation, almost always occurring in association with struc- tural 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 dis- crete P waves. The ventricular response is often irregu- larly 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]. * Correspondence: peter.morelli@stonybrook.edu 3Stony Brook University Department of Pediatric Cardiology, HSC T-11, 040, Stony Brook, NY, 11794-8111, USA Full list of author information is available at the end of the article Exogenous causes of atrial fibrillation through a sub- strate such as caffeine have not been widely reported in the literature, especially in the pediatric population. A large-scale Danish study evaluating adult human caf- feine 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 © 2011 Di Rocco et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.