<p>Caffeine consumption among children and adolescents has increased in recent years, largely through energy drinks. While caffeine is generally considerd as safe in low doses, current evidence suggests that high intake may provoke arrhythmias and electrocardiographic abnormalities in younger populations. This systematic review evaluates the arrhythmogenic effects of caffeine consumption in pediatric and adolescent patients. This review followed PRISMA 2020 guidelines and was registered in PROSPERO (ID 1180917). A systematic search of PubMed, EMBASE, and Cochrane CENTRAL identified studies evaluating caffeine-related arrhythmias in individuals under 19 years of age. Eligible publications included peer-reviewed studies, case reports, and case series reporting arrhythmogenic or electrocardiographic outcomes. Screening and data extraction were performed independently by two reviewers using Covidence. The search yielded 126 articles, of which 12 met the inclusion criteria. These comprised 9 case reports, 1 prospective study, 1 retrospective study, and 1 review including an unpublished case report. Across all eligible studies, a total of 39 adolescents (aged 13–18 years) were reported to have caffeine associated arrhythmias or ECG changes. Caffeine sources included energy drinks, caffeine containing tablets and powdered caffeine. Reported cardiac side effects ranged from sinus tachycardia and premature atrial or ventricular contractions to supraventricular tachycardia, ventricular tachycardia, QTc prolongation and ST-segment abnormalities. This systematic review demonstrates that high dose caffeine from sources like energy drinks, powders and tablets can induce a range of cardiac arrhythmias and electrophysiological abnormalities. Our findings underscore the need for increased awareness and improved public health education regarding the cardiovascular danger of high-dose caffeine in this population.</p>