Consuming Caffeinated Coffee After Cardioversion Is Associated With a Lower Risk of Recurrent AF Compared With No Caffeine

Does the avoidance of caffeine, compared with consuming caffeinated coffee, following cardioversion reduce the risk of recurrent atrial fibrillation (AF)?

The risk of recurrent AF following successful cardioversion is lower in adults who consume coffee with caffeine (in this study, one cup per day) compared with those who avoid caffeine. (Level of Evidence = 1b)

Traditional clinical experience considers caffeine to be proarrhythmic. The investigators identified coffee-drinking adults, 21 years or older, with sustained AF or atrial flutter with a history of AF who were undergoing electrical cardioversion. Following sustained successful cardioversion, consenting patients (N = 200) were randomly assigned to consumption of at least one cup of coffee with caffeine daily or abstinence from caffeine-containing products. The primary outcome of recurrent AF or atrial flutter lasting at least 30 seconds required confirmation by physician interpretation of a standard cardiac rhythm monitoring device. Complete follow-up occurred for all participants at 6 months.

Using intention-to-treat analysis, recurrence of AF or atrial flutter occurred significantly less often in the caffeine-consumption group than in the caffeine-avoidance group (47% vs 64%, respectively). Adverse events that required hospitalization occurred numerically more often in the caffeine-avoidance group than in the caffeine-consumption group (15 vs 10, respectively).

Study Design: Randomized controlled trial (single-blinded)

Funding Source: Government

Allocation: Concealed

Setting: Outpatient (specialty)

Reference: Wong CX, Cheung CC, Montenegro G, et al. Caffeinated coffee consumption or abstinence to reduce atrial fibrillation: the DECAF randomized clinical trial. JAMA. 2026; 335(4): 317-325.