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ABSTRACT
Limited data exist on the safety and physiologic effects of caffeine in patients with known arrhythmias. The
studies presented suggest that in most patients with known or suspected arrhythmia, caffeine in moderate
doses is well tolerated and there is therefore no reason to restrict ingestion of caffeine. A review of the
literature is presented.
2011 Elsevier Inc. All rights reserved. The American Journal of Medicine (2011) 124, 284-289
KEYWORDS: Arrhythmia; Caffeine
0002-9343/$ -see front matter 2011 Elsevier Inc. All rights reserved.
doi:10.1016/j.amjmed.2010.10.017
285
286
Table
Reference
Year
Description
2005
47,949
Conen et al38
2010
33,638
Prineas et al39
1980
7311
de Vreede-Swagemakers et al40
1999
117
DeBacker et al41
1979
81
Myers et al42
1987
70
Clee et al43
1979
50
Graboys et al44
1989
50
1990
35
Sutherland et al46
1985
18
Newby et al47
1996
13
37
287
sudden cardiac arrest revealed an impressive association of
heavy coffee consumption (10 cups per day) with increased risk of sudden cardiac death, with an odds ratio of
55.7 (95% condence interval, 6.4-483) compared with
matched controls with coronary artery disease.40 However,
only 2 of the control subjects drank more than 10 cups of
coffee per day, and therefore the size of the control group
may have been inadequate. Larger-scale epidemiologic
studies have been performed showing no association of
caffeine intake with increased arrhythmias. In the Danish
Diet, Cancer, and Health study, 47,949 subjects with a mean
age of 56 years were followed on average for 5.7 years.37
This study found no association between caffeine use and
development of atrial arrhythmias. In the Womens Health
Study, in which 33,638 women were followed for an average of 14.4 years, caffeine consumption also was not associated with an increased incidence of atrial brillation.38 A
trial of 81 healthy men with frequent PVCs who abstained
from caffeine found no change in frequency of PVC as
measured by 24-hour electrocardiography.41 Additionally,
in a study of 50 healthy elderly subjects followed by a
continuous ECG, caffeine was not linked to an increase in
atrial or ventricular ectopy despite a high prevalence of
baseline ectopy in the study population.43 Furthermore, a
randomized trial of 13 patients with symptomatic idiopathic
PVC compared the management of these patients with and
without caffeine restriction and found no change in frequency of ectopic complexes or symptoms with avoidance
of caffeine.47 The disparities in these reports may relate to
the arrhythmias evaluated, the underlying cardiac substrate,
or methodologic issues.
288
ologic studies, it is unlikely that the majority of patients are
sensitive to the effects of caffeine. Nevertheless, there may
be individuals who are susceptible to the small electrophysiologic changes induced by caffeine and therefore may experience arrhythmias with caffeine.
Although it has been shown that patients with frequent
ventricular ectopy can have an increase in frequency of their
arrhythmia with caffeine ingestion,46 high-risk patients such
as those with recent myocardial infarction,42,45 nonsustained ventricular tachycardia,43 and malignant ventricular
arrhythmia44 have been studied with no increase in frequency or severity of arrhythmia. These studies provide
evidence that caffeine may not be harmful even in patients
who are at risk of malignant arrhythmia.
There are signicant limitations in our knowledge about
the relationship between caffeine and arrhythmia. Although
large-scale epidemiologic human studies do exist, they did
not study patients with malignant arrhythmias. Therefore,
we rely on smaller studies to make inferences about outcomes in these patients. Several studies did evaluate the
arrhythmias of interest; they were limited by a short time
period of results and therefore cannot capture infrequent
outcome events. In addition, specic arrhythmias such as
catecholaminergic polymorphic ventricular tachycardia
have not been studied, although survey evidence exists to
suggest that caffeine increases the frequency of right ventricular outow tract tachycardia.52 Patients who state that
their arrhythmias are triggered by caffeine intake have not
been studied in adequate depth to draw conclusions about
the safety of caffeine ingestion. In these cases, it is prudent
to abstain from caffeine until further information is
available.
Overall, the data suggest that in most patients, even those
with known or suspected arrhythmia, caffeine in moderate
doses is well tolerated and there is therefore no reason to
restrict ingestion of caffeine. Care should be taken to avoid
caffeine in situations in which catecholamines are thought
to drive the arrhythmia, as well as in patients who note
sensitivity to caffeine.
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