CLINICAL QUESTION: What effect does coffee consumption have on atrial fibrillation (AF) after successful electrical cardioversion?
BACKGROUND: Coffee is one of the most-consumed beverages, and it has traditionally been considered proarrhythmic, leading many physicians to advise patients with AF to reduce or eliminate their intake. While some recent observational studies have suggested a neutral or potentially protective association, these findings are often limited by confounding factors, and no randomized clinical trial has previously addressed this question.
STUDY DESIGN: Prospective, open-label, multicenter, randomized clinical trial (The DECAF Trial)
SETTING: Five hospitals in the U.S., Canada, and Australia
SYNOPSIS: This study investigated the impact of coffee consumption on AF recurrence following electrical cardioversion. The trial enrolled 200 adults with persistent AF or atrial flutter and were randomized in a 1:1 ratio to receive daily caffeinated coffee consumption (at least one cup) or total caffeine abstinence for six months.
The findings suggest that coffee may actually have a protective effect: AF or atrial flutter recurred in 47% of the coffee group compared to 64% in the abstinence group (HR, 0.61; 95% CI, 0.42 to 0.89), with moderate certainty in evidence (risk of bias). Similar benefits were noted for AF-only recurrence. Additionally, the abstinence group had higher rates of arrhythmia-related hospitalizations (15 versus 10). As limitations, the researchers noted that the study was unblinded and relied on clinically detected events. Furthermore, adherence was a challenge, as only 69% of the abstinence group successfully avoided coffee throughout the study period.
BOTTOM LINE: Daily coffee consumption is associated with a lower risk of AF recurrence compared to total caffeine abstinence.
CITATION: Wong CX, et al. Caffeinated coffee consumption or abstinence to reduce atrial fibrillation: the DECAF randomized clinical trial. JAMA. 2026;335(4):317-325. doi: 10.1001/ jama.2025.21056.
Dr. Ozon is a hospitalist in the department of clinical medicine at Hospital Aleman, a professor of pharmacology at the Buenos Aires University, and an instructor of internal medicine at the University of Salvador, all in Buenos Aires, Argentina.