Consumption of Caffeinated Products and Cardiac Ectopy.

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.

The effect of antiarrhythmic medication management on atrial fibrillation ablation outcomes.

BACKGROUND: Patients commonly present for atrial fibrillation (AF) ablation while taking antiarrhythmic (AA) medications. It is unknown if AA use at the time of ablation affects procedural outcome. This study compares the AF ablation outcomes of patients who underwent ablation while on AA medications to those who were not on AA medications. METHODS AND RESULTS: A total of 180 consecutive patients who underwent their first catheter ablation of AF were identified from the Johns Hopkins Hospital AF registry and divided into 2 cohorts: those On AA at the time of ablation (127 patients, mean follow-up 24.6 months) and those Off AA at the time of ablation (53 patients, mean follow-up 20.3 months). Follow-up was performed to identify recurrent AF. There was no statistically significant difference in the percentage of patients without a recurrence of symptomatic AF (single procedure success rate) in the On and Off AA groups at 6 months postablation (53.5% vs 50.1%, P = 0.75), or by the end of follow-up (37.8% vs 41.5%, P = 0.64). For those patients who had symptomatic AF recurrence, the average time to recurrence was 6.2 ± 9.0 months in the On AA group and 4.2 ± 7.2 months in the Off AA group (P = 0.27). CONCLUSIONS: There was no statistically significant difference in the rate of symptomatic AF recurrence between the On AA and Off AA groups in this study. The use of AA medications at the time of ablation does not appear to affect procedural outcomes in this population.