Abstract 17154: Arrhythmias Associated With Acute Caffeine Toxicity

Introduction: Recent evidence has failed to demonstrate an association between caffeine consumption and arrhythmias. However, case reports have suggested an increased risk of arrhythmias associated with excessive caffeine intake. This relationship has yet to be studied in a large population.

Goals: To describe the frequency and types of arrhythmias associated with caffeine toxicity.

Methods: We used Emergency Department (ED) data from the California Department of Health Care Access and Information to identify California residents aged ≥ 18 years between January 1, 2005 to December 31, 2020. Caffeine toxicity and arrhythmias were identified using ICD9/10 codes. Multivariable logistic regression models were used to compare the frequency of arrhythmias between those with caffeine toxicity to those visiting the ED for any other reason.

Results: Among 23,755,762 patients, 725 (< 0.01%) had caffeine toxicity. Those with caffeine toxicity were younger (mean 28.9 ± 12.1 years), male (67.0%), of lower income, and had less cardiovascular comorbidities. Of these, 4 (0.6%) had atrial fibrillation, 3 (0.4%) supraventricular tachycardia, 2 (0.3%) premature ventricular contractions, 1 (0.1%) cardiac arrest, and 7 (1.0%) unspecified arrhythmias. No one with caffeine toxicity had premature atrial contractions, ventricular tachycardia or fibrillation. Before adjustment, caffeine toxicity was 1.7 times more likely to be associated with an arrhythmia (odds ratio [OR] 1.70, 95% confidence interval [CI] 1.05 to 2.75). After adjustment, caffeine toxicity was 7 times more likely to be associated with an arrhythmia (OR 6.81, 95% CI 4.13 to 11.24) ( Figure ).

Conclusions: Caffeine toxicity was strongly associated with both atrial and ventricular arrhythmias. While recent studies found no increased risk of arrhythmias associated with regular caffeine consumption, these data suggest that excessive caffeine intake may yet heighten the likelihood an arrhythmia may occur.