The link between coffee consumption and arrhythmia has been met with contradicting recommendations. It is widely believed that caffeine could trigger atrial fibrillation (AF) and other arrhythmias in predisposed individuals. Yet, no randomized studies have so far assessed its actual impact on AF patients.
The DECAF was a prospective, prospective, open-label, randomized clinical trial, with blinded event assessment, assigning patients 1:1 to caffeinated coffee (≥1 cup a day) or total abstinence from caffeine in all its forms, for 6 months. AF adult patients were enrolled (or patients with atrial flutter and a history of AF) undergoing electrical cardioversion, with regular coffee intake (≥1 cup a day) for the last 5 years.
The primary outcome was clinical AF recurrence or atrial flutter lasting ≥30 seconds, at 6 months. Patients with 3-month prior AF ablation, cardiothoracic surgery or failed cardioversion, were excluded.
200 patients were randomized, mean age 68, with mean CHA₂DS₂-VASc 2.5, 40% treated with class III anti-arrhythmia.
Upon primary analysis, it was found that coffee consumption reduced AF recurrence or atrial flutter by 39% (HR 0.61; CI95% 0.42–0.89; p=0.001). Even though only 69% in the abstinence group met the restriction requirements; at prespecified per-protocol analysis, the benefit of caffeine was even more significant (HR 0.53; CI95% 0.36–0.78; p=0.002).
Conclusions
In patients with AF undergoing successful electrical cardioversion, regular consumption of caffeinated coffee did not increase arrhythmia recurrence; on the contrary, it was associated with lower incidence of AF or atrial flutter vs. abstinence.
Presented by Christopher X. Wong, Late-Breaking Science, AHA 2025, New Orleans, USA.
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