Successful improvement of ventricular arrhythmic burden after discontinuation of stimulant supplements in structurally normal young patients

Introduction

The increasing consumption of energy drinks and high-dose pre-workout stimulant supplements has raised concerns regarding their association with ventricular arrhythmias, including non-sustained ventricular tachycardia (NSVT), in young individuals without structural heart disease. Even in the presence of normal cardiac imaging, high-level stimulant exposure may act as an underrecognized arrhythmic trigger.

Objective

To evaluate ventricular arrhythmias in young patients using stimulant supplements and to assess arrhythmic reversibility after discontinuation.

Methods

A two-phase longitudinal analytical study was conducted including patients aged 15–40 years presenting with palpitations and NSVT on 24-hour Holter monitoring (April 2024–December 2025). All patients had normal echocardiography, cardiac magnetic resonance imaging, exercise testing, and laboratory evaluation.

In Phase 1 (n=152), stimulant use was associated with a significantly higher prevalence of premature ventricular complexes (PVCs) compared with non-users (68% vs 35%).

Phase 2 focused on arrhythmic reversibility after stimulant discontinuation (n=81; 90-day follow-up). The primary endpoint was significant PVC burden (>5%), and the secondary endpoint was NSVT occurrence.

Results

Among the 81 stimulant users included in Phase 2, 59 (72.8%) presented PVC arrhythmias at baseline. Discontinuation of stimulant substances led to a marked reduction in PVC burden >5% on 24-hour Holter monitoring, decreasing from 60.5% at baseline to 12.3% after 90 days (RR 0.20; 95% CI 0.11–0.36; p<0.00001), corresponding to an 80% relative risk reduction and 48% absolute risk reduction (NNT ≈ 2), according to McNemar’s test.

Among patients (n=10) with baseline PVC burden <5%, 100% demonstrated improvement: 8 achieved complete resolution and 2 showed reduction to <1%.

See Attached 1

NSVT resolved in 72.7% of cases after discontinuation (RR 0.27; 95% CI 0.08–0.87; p=0.016). Persistence of arrhythmia was more frequent in patients with baseline PVC burden >10%, suggesting a dose–response gradient.

Conclusion

High-dose stimulant supplement use is associated with increased ventricular arrhythmic burden in structurally normal young patients. The statistically robust reversibility observed after discontinuation strengthens the plausibility of a causal relationship and identifies stimulant exposure as a modifiable arrhythmic risk factor in this population traditionally considered low risk.

Further large-scale studies are warranted.attached 1