Wong Christopher X, Cheung Christopher C, Montenegro Gabrielle, Oo Hannah H, Peña Isabella J, Tang Janet J, Tu Samuel J, Wall Grace, Dewland Thomas A, Moss Joshua D, Gerstenfeld Edward P, Tseng Zian H, Hsia Henry H, Lee Randall J, Olgin Jeffrey E, Vedantham Vasanth, Scheinman Melvin M, Lee Catherine, Sanders Prashanthan, Marcus Gregory M
Division of Cardiology, University of California San Francisco.
Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia.
JAMA. 2025 Nov 9. doi: 10.1001/jama.2025.21056.
Conventional wisdom holds that caffeinated coffee is proarrhythmic. Coffee is the most commonly consumed caffeinated beverage in the US, and a randomized trial assessing caffeinated coffee consumption in patients with atrial fibrillation (AF) has not previously been performed.
To determine the effect of caffeinated coffee consumption compared with abstinence from coffee and caffeine on recurrent AF.
DESIGN, SETTING, AND PARTICIPANTS: This was a prospective, open-label, randomized clinical trial enrolling 200 current or previous (within past 5 years) coffee-drinking adults with persistent AF, or atrial flutter with a history of AF, planned for electrical cardioversion from 5 hospitals in the US, Canada, and Australia between November 2021 and December 2024. The date of final follow-up was June 5, 2025.
Patients were randomized in a 1:1 ratio to regular caffeinated coffee consumption vs coffee and caffeine abstinence for 6 months. Patients in the coffee consumption group were encouraged to drink at least 1 cup of caffeinated coffee daily. Patients in the abstinence group were encouraged to completely abstain from both caffeinated and decaffeinated coffee and other caffeine-containing products.
The primary end point was clinically detected recurrence of AF or atrial flutter over 6 months.
Two hundred patients (mean [SD] age, 69 [11] years; 71% male) were randomized to caffeinated coffee consumption (n = 100) or coffee abstinence (n = 100). Baseline coffee intake was 7 cups (IQR, 7-18) per week in both groups. During follow-up, coffee intake in the consumption and abstinence groups was 7 (IQR, 6-11) and 0 (IQR, 0-2) cups per week, respectively, resulting in a between-group difference of 7 cups (95% CI, 7-7) per week. In the primary analysis, AF or atrial flutter recurrence was less in the coffee consumption (47%) than the coffee abstinence (64%) group, resulting in a 39% lower hazard of recurrence (hazard ratio, 0.61 [95% CI, 0.42-0.89]; P = .01). A comparable benefit of coffee consumption was observed with AF recurrence only. There was no significant difference in adverse events.
In this clinical trial of coffee drinkers after successful cardioversion, allocation to consumption of caffeinated coffee averaging 1 cup a day was associated with less recurrence of AF or atrial flutter compared with abstinence from coffee and caffeinated products.
ClinicalTrials.gov Identifier: NCT05121519.
传统观点认为含咖啡因的咖啡会诱发心律失常。咖啡是美国消费最为普遍的含咖啡因饮品，此前尚未进行过一项针对心房颤动（AF）患者饮用含咖啡因咖啡的随机试验。
确定饮用含咖啡因咖啡与不喝咖啡及不摄入咖啡因相比对房颤复发的影响。
设计、地点和参与者：这是一项前瞻性、开放标签、随机临床试验，招募了200名目前或过去（过去5年内）有喝咖啡习惯的持续性房颤或有房颤病史的心房扑动成年患者，计划于2021年11月至2024年12月期间在美国、加拿大和澳大利亚的5家医院进行心脏电复律。最终随访日期为2025年6月5日。
患者按1:1比例随机分为常规饮用含咖啡因咖啡组与戒咖啡和咖啡因组，为期6个月。饮用咖啡组的患者被鼓励每天至少饮用1杯含咖啡因咖啡。戒断组的患者被鼓励完全戒除含咖啡因和不含咖啡因的咖啡以及其他含咖啡因产品。
主要终点是6个月内临床检测到的房颤或心房扑动复发。
200名患者（平均[标准差]年龄，69[11]岁；71%为男性）被随机分为饮用含咖啡因咖啡组（n = 100）或戒咖啡组（n = 100）。两组的基线咖啡摄入量均为每周7杯（四分位间距，7 - 18）。在随访期间，饮用组和戒断组的咖啡摄入量分别为每周7杯（四分位间距，6 - 11）和0杯（四分位间距，0 - 2），组间差异为每周7杯（95%置信区间，7 - 7）。在初步分析中，饮用咖啡组房颤或心房扑动复发率（47%）低于戒咖啡组（64%），复发风险降低39%（风险比，0.61[95%置信区间，0.42 - 0.89]；P = 0.01）。仅在房颤复发方面观察到饮用咖啡有类似益处。不良事件无显著差异。
在这项心脏电复律成功后的咖啡饮用者临床试验中，与戒除咖啡和含咖啡因产品相比，分配到平均每天饮用1杯含咖啡因咖啡的组房颤或心房扑动复发较少。
ClinicalTrials.gov标识符：NCT05121519。
