Physicians' Academy for Cardiovascular Education

Coffee consumption not associated with atrial arrhythmias in healthy individuals

Acute Effects of Coffee Consumption on Health among Ambulatory Adults

Literature - Marcus GM, Rosenthal DG, Nah G, et al. - N Engl J Med. 2023 Mar 23;388(12):1092-1100. doi: 10.1056/NEJMoa2204737.

Introduction and methods


Coffee is one of the most commonly consumed beverages worldwide, but the acute health effects of coffee consumption remain largely uncertain [1]. Coffee consumption is often discouraged due to assumed proarrhythmic effects [2], but data supporting this warning is conflicting [3-6].

Aim of the study

The authors investigated the acute effects of caffeinated coffee consumption on cardiac ectopy, physical activity, sleep, and glucose levels in healthy individuals.



The CRAVE (Coffee and Real-time Atrial and Ventricular Ectopy) trial was an prospective, randomized, single-center, case-crossover trial, conducted during a 14-day period. 100 healthy adults (mean age 39 years, 51% female) were randomly assigned to alternate between consuming and avoiding caffeinated coffee during 2-day periods. The participants were informed about the assignment via daily text messages. Participants were fitted with a continuously recording electrocardiogram (ECG), wrist-worn accelerometer to register step counts and sleep duration, and a continuously recording glucose monitoring device. Participants used a smartphone app to continuously monitor their geolocation data to track visits to coffeeshops. Individuals were excluded if they had a history of AF or HF; had an implanted pacemaker or cardioverter-defibrillator; had been prescribed beta-blockers, nondihydropyridine calcium-channel blockers or Vaughn–Williams class 1 or 3 antiarrhythmic medications; or had a medical reason to avoid coffee.


The primary outcome was the number of premature atrial contractions per 24h period.

Main results


Consumption of caffeinated coffee was not associated with premature atrial contractions in healthy participants compared to the avoidance of caffeine. On the other hand, consumption of caffeinated coffee was associated with more premature ventricular contractions, more physical activity, and less sleep.


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Find this article online at N Engl J Med.

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