Review
Caffeine and Cardiac Arrhythmias: A Review of the Evidence

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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.

Section snippets

Caffeine and Cardiovascular Disease

Caffeine is a nonselective competitive antagonist of adenosine receptor subtypes A1 and A2A in concentrations typically consumed by humans. At higher concentrations, caffeine can induce intracellular calcium release and phosphodiesterase inhibition, and at higher doses not typically consumed, can cause gamma-aminobutyric acid inhibition.8 It is suggested that 100 mg can increase alertness in humans. Increases in blood pressure are noted at 250 mg, and the lethal dose has been estimated to be 10

Effects of Caffeine on the Human Electrocardiogram

Donnerstein et al26 performed signal-averaged electrocardiograms (ECGs) in 12 subjects given a 5 mg/kg dose of caffeine. Compared with placebo, there was an increase in QRS duration with caffeine ingestion; the small magnitude of this change, approximately 1 ms, is likely clinically insignificant, although it reached statistical significance. P-wave duration and heart rate remained unchanged. Caron et al27 performed a study in which 10 healthy volunteers were given caffeine (400 mg) and

Animal Studies of Caffeine and Arrhythmia

Animal studies allow investigators to probe the link between caffeine and arrhythmia in ways that are impossible using human subjects. Higher-dose caffeine protocols are typically used. Additionally, invasive studies and evaluations of the concomitant effects of ischemia that would be impossible to perform on human subjects are frequently employed. Bellet et al28 performed a pivotal study in 1972 examining the effect of caffeine on the ventricular fibrillation threshold. In this experiment, the

Human Studies of Caffeine and Arrhythmia

Several human studies have been performed to investigate the effect of caffeine on atrial and ventricular arrhythmias (Table).37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47 Both physiologic and epidemiologic studies have been performed.

Early human studies were performed using invasive electrophysiology studies. Gould et al48 obtained His bundle electrograms in 12 patients with known cardiovascular disease before and after ingestion of a 150-mg dose of caffeine.48 There were no changes in

Discussion and Recommendations

With the conflicting data that are available, it is understandable that most physicians are unsure of the advice they can provide about caffeine intake and arrhythmias. A common idea in practice is that caffeine intake should be limited in patients at risk for arrhythmia; however, it is unclear what evidence provides support for this. Although this advice is frequently given to patients,7 many of the data that have been reviewed suggest that this advice is unnecessary.

Although animal studies

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      The following sections provide results for: arrhythmias, heart rate and blood pressure, cholesterol, platelet function, and endothelial cell regeneration. In healthy humans, emerging evidence suggests that coffee consumption is associated with neutral to reduced risk for arrhythmias (Higdon and Frei, 2006; Pelchovitz and Goldberger, 2011). In contrast to the emerging human evidence, some animal studies (Bellet et al., 1972; Ishida et al., 1996; Mehta et al., 1997) have reported caffeine-induced ventricular arrhythmias; although this pro-arrhythmic effect has not been consistently found in all animal studies (Rashid et al., 2006; Ilback et al., 2007).

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    Funding: None.

    Conflict of Interest: Jeffrey J. Goldberger, MD, is a consultant for Red Bull GmbH.

    Authorship: Both authors had access to the data and had a key role in writing the manuscript.

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