Caffeinated coffee lowered atrial fibrillation recurrence
Among regular coffee drinkers after cardioversion, continuing caffeinated coffee reduced return of atrial fibrillation or flutter versus abstaining from coffee and caffeine.
*Randomized clinical trial; Level 1b (OCEBM).

Citation

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. doi:10.1001/jama.2025.21056.

Background

Caffeinated coffee is often believed to trigger abnormal heart rhythms, yet high-quality trial evidence in people with atrial fibrillation has been limited. This trial tested whether coffee continuation is harmful or helpful after restoring normal rhythm.

Patients

200 adults (mean age 69 years; 71% men) with persistent atrial fibrillation (or atrial flutter with a history of atrial fibrillation) who were current or recent coffee drinkers and had a sustained successful electrical cardioversion. Key exclusions: adverse reaction to coffee, inability to adhere, planned ablation or heart surgery within 3 months, pregnancy.

Intervention

Regular caffeinated coffee (encouraged ≥1 cup daily) and usual caffeinated products.

Control

Abstinence from coffee (including decaffeinated) and other caffeine-containing products.

Outcome

Clinically detected recurrence of atrial fibrillation or atrial flutter lasting ≥30 seconds.

Follow-up Period

6 months

Results

Outcome Coffee consumption Abstinence Effect
Recurrence of atrial fibrillation or flutter (primary) 47/100 (47%) 64/100 (64%) Hazard ratio 0.61 (95% confidence interval, 0.42 to 0.89); absolute risk reduction 17%; number needed to treat: 6
Analysis was intention-to-treat. No clear difference in adverse events was reported.

Limitations

Open-label design and recurrence was based on clinical detection without a required monitoring schedule, so some episodes may have been missed. Adherence was imperfect in the abstinence group. The study was modest in size and limited to persistent atrial fibrillation patients after successful cardioversion, which may limit generalizability.

Funding

Public and nonprofit funders; no role in study conduct.

Clinical Application

For persistent atrial fibrillation patients who already drink coffee, routine caffeinated coffee avoidance after cardioversion is not supported and may be counterproductive.