For years and years, physicians—including me—have told patients with atrial and ventricular arrhythmia to forgo the pleasures of chocolate and coffee.

A study presented during a featured poster session at the Heart Rhythm Society 2015 Scientific Sessions suggests we were wrong.[1] Thank goodness. (I'll pause a moment for a sip of espresso.)

The joyous poster was born from the database of the Cardiovascular Health Study, which is a population-based cohort in the US. CHS began in 1989 and followed more than 5000 patients over the age of 65.

Investigators from San Francisco, St Louis, and Portland asked the question of whether the common dogma of caffeine avoidance in patients with atrial and ventricular ectopy was wise. It is an important question because the antioxidant properties of dark chocolate, coffee, and tea may confer health benefits. Plus, we ask patients with arrhythmia to give up many of life's pleasures—calories and alcohol and sometimes triathlons, for instance. If we also take their coffee or chocolate, we surely do a lot.

The research team quantified premature atrial contractions (PACs) and premature ventricular contractions (PVCs) in the 1414 individuals who were randomly assigned to have 24-hour Holter monitors. They then compared that data with self-reported food frequency questionnaire and did the usual statistics to assess for associations.

They found none. Coffee, tea, and chocolate consumption did not associate with PAC or PVC frequency.

The authors noted CHS was the largest cohort study to look at dietary data and cardiac ectopy. And their findings suggest "clinical recommendations advising against the consumption of caffeinated products in patients with PACs and PVCs should be reconsidered."

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The first thing to note is the title of the poster. The authors used the term "healthy" caffeinated products for a good reason. They looked at natural products like chocolate, coffee, and tea—not amped up, calorie-laden sports drinks. Recall that a cup of black coffee has less than 10 calories.

Second, we can agree that observational trials have weaknesses. They used self-reported diet questionnaires, the groups were not randomized, and 24-hour samples of ectopy may not be representative of overall arrhythmia burden.

Yet the findings align well with prior heart-rhythm data. This 2014 meta-analysis of caffeine risk in patients with atrial fibrillation concluded that the relationship was inverse.[2] Habitual caffeine consumption may actually reduce AF risk.

The caffeine-health narrative was just covered in the New York Times.[3] Dr Aaron Carroll, an Indiana University pediatrician, health policy professor, and explanatory health journalist, summed up the evidence on "healthy" caffeine products and came to the conclusion that "it's way past time that we stopped viewing coffee as something we all need to cut back on."

This abstract changes my practice. And here we have a medical reversal that is cause for celebration.

JMM

 

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