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

  • The mean number of premature atrial contractions per day was similar when participants consumed coffee compared to caffeine-avoidance days (58 vs. 53, respectively; rate ratio: 1.09; 95%CI: 0.98-1.20; P=0.10).
  • The mean number of premature ventricular contractions per day was higher when participants consumed coffee compared to caffeine-avoidance days (154 vs. 102, respectively; rate ratio: 1.51; 95%CI: 1.18-1.94).
  • The mean number of daily episodes of nonsustained supraventricular tachycardia and nonsustained ventricular tachycardia was similar when participants consumed coffee compared to caffeine-avoidance days (0.17 vs. 0.20, respectively; rate ratio: 0.83; 95%CI: 0.68-1.02; for nonsustained supraventricular tachycardia; and 0.01 vs. 0.01, respectively; rate ratio: 1.14; 95%CI: 0.43-2.99; for nonsustained ventricular tachycardia).
  • Daily step count was higher on days when participants consumed coffee compared to caffeine-avoidance days (mean difference: 1058; 95%CI: 441-1675).
  • Sleep duration per night was lower on days when participants consumed coffee compared to caffeine-avoidance days (mean difference: 36 minutes; 95%CI: 25-47).
  • Daily average glucose levels were similar on days when participants consumed coffee compared to caffeine-avoidance days (mean difference: -0.41; 95%CI: -5.42-4.60).
  • Participants drank more coffee compared to their usual amounts of coffee on days when they were assigned to consume coffee.


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.


1. Van Dam, RM, Hu FB, and Willett WC. Coffee, caffeine, and health. N Engl J Med. 2020;383(4):369-378

2. Al-Khatib SM, Stevenson WG, Ackerman MJ, et al. 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation. 2018;138(13):e210-e271.

3. Dixit S, Stein PK, Dewland TA, et al. Consumption of caffeinated products and cardiac ectopy. J Am Heart Assoc. 2016;5(1):e002503.

4. Kim EJ, Hoffmann TJ, Nah G, et al. Coffee Consumption and incident tachyarrhythmias: reported behavior, mendelian randomization, and their interactions. JAMA Intern Med. 2021 Sep 1;181(9):1185-1193.

5. Bodar V, Chen J, Gaziano JM, et al. Coffee consumption and risk of atrial fibrillation in the Physicians’ Health Study. J Am Heart Assoc. 2019;8(15):e011346.

6. Caldeira D, Martins C, Alves LB, et al. Caffeine does not increase the risk of atrial fibrillation: a systematic review and meta-analysis of observational studies. Heart. 2013;99(19):1383-9.

Find this article online at N Engl J Med.

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