Arrhythmia and Electrophysiology Consumption of Caffeinated Products and Cardiac Ectopy

But did they consider those studies that have identified a single nugget of our DNA that seems to determine whether we process caffeine quickly or slowly? That, in turn, appears to have a large effect on whether coffee is good for your health.  Sometimes I wonder if anyone in stroke has a thinking cap or is it tin foil.

Arrhythmia and Electrophysiology Consumption of Caffeinated Products and Cardiac Ectopy

1. Shalini Dixit, BA¹;
2. Phyllis K. Stein, PhD²;
3. Thomas A. Dewland, MD³;
4. Jonathan W. Dukes, MD¹;
5. Eric Vittinghoff, PhD¹;
6. Susan R. Heckbert, MD, PhD⁴;
7. Gregory M. Marcus, MD, MAS¹

+ Author Affiliations

1. ¹University of California, San Francisco, San Francisco, CA (S.D., J.W.D., E.V., G.M.M.)
2. ²Washington University School of Medicine, St. Louis, MO (P.K.S.)
3. ³Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR (T.A.D.)
4. ⁴University of Washington and Group Health Research Institute, Seattle, WA (S.R.H.)

1. Correspondence to:
   Gregory M. Marcus, MD, MAS, 505 Parnassus Ave, M‐1180B, Box 0124, San Francisco, CA 94143‐0124. E‐mail: marcusg@medicine.ucsf.edu

• Received August 5, 2015.
• Accepted December 3, 2015.

• © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

 

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Abstract

Background Premature cardiac contractions are associated with increased morbidity and mortality. Though experts associate premature atrial contractions (PACs) and premature ventricular contractions (PVCs) with caffeine, there are no data to support this relationship in the general population. As certain caffeinated products may have cardiovascular benefits, recommendations against them may be detrimental.

Methods and Results We studied Cardiovascular Health Study participants with a baseline food frequency assessment, 24‐hour ambulatory electrocardiography (Holter) monitoring, and without persistent atrial fibrillation. Frequencies of habitual coffee, tea, and chocolate consumption were assessed using a picture‐sort food frequency survey. The main outcomes were PACs/h and PVCs/hour. Among 1388 participants (46% male, mean age 72 years), 840 (61%) consumed ≥1 caffeinated product per day. The median numbers of PACs and PVCs/h and interquartile ranges were 3 (1–12) and 1 (0–7), respectively. There were no differences in the number of PACs or PVCs/h across levels of coffee, tea, and chocolate consumption. After adjustment for potential confounders, more frequent consumption of these products was not associated with ectopy. In examining combined dietary intake of coffee, tea, and chocolate as a continuous measure, no relationships were observed after multivariable adjustment: 0.48% fewer PACs/h (95% CI −4.60 to 3.64) and 2.87% fewer PVCs/h (95% CI −8.18 to 2.43) per 1‐serving/week increase in consumption.

Conclusions In the largest study to evaluate dietary patterns and quantify cardiac ectopy using 24‐hour Holter monitoring, we found no relationship between chronic consumption of caffeinated products and ectopy.

Introduction

Premature cardiac contractions, otherwise known as atrial and ventricular ectopy, are common throughout the general population.^1–2 Previously, these ectopic beats were believed to be harmless in the absence of known cardiovascular disease or symptoms; however, there is now evidence to indicate that premature atrial contractions (PACs) and premature ventricular contractions (PVCs) are associated with increased cardiovascular morbidity and mortality. PACs are known to initiate paroxysms of atrial fibrillation (AF), and targeted ablation of ectopic foci in the atria can eliminate or significantly reduce AF recurrence.³ In addition, we previously showed that the PAC count is a particularly useful predictor of incident AF in older adults,⁴ and others have demonstrated that increased PACs in apparently healthy individuals are associated with incident AF, stroke, and death.⁵ With regard to PVCs, the presence of even one PVC during a 2‐minute ECG has been associated with an increased risk of incident congestive heart failure (CHF), coronary artery disease (CAD) events, and CAD‐related death.^6–7 Additionally, our group has previously demonstrated that a higher frequency of PVCs is associated with an increase in incident CHF and with increased mortality.⁸ Furthermore, recent evidence from the electrophysiology laboratory has shown that eradication of PVCs via radiofrequency ablation among patients with idiopathic systolic heart failure can normalize ventricular function, suggesting that PVCs alone are sufficient to result in heart failure.⁹

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