Cannabis use and atrial arrhythmias: A systematic review and meta-analysis of large populational studies

Delta-9-tetrahydrocannabinol, a major component of cannabis, causes sympathetic stimulation and endothelial dysfunction. A recent American Heart Association consensus document has outlined cardiovascular risks associated with cannabis use. However, there are limited data surrounding atrial arrhythmias (AA).

This study aimed to investigate the association between cannabis use and the risk of AAs.

MEDLINE, Embase, and Cochrane Central Register of Controlled Trials were searched for articles published up to April 2024 for studies on cannabis use and AAs (atrial fibrillation/flutter/tachycardia, supraventricular tachycardia). Odds ratios (OR) and 95% confidence intervals (CIs) were pooled using a random-effects model. The study was prospectively registered (PROSPERO CRD42023428219).

Fourteen observational studies were included with 81,230,930 participants from North America, Europe, and Oceania. Mean age was 47.2 years; 63.3% of participants were female. Five studies were prospective. AA was observed in 1.9% of participants (n = 1,578,033), that is, 12.5% of cannabis users (n = 90,195) and 2.7% of controls (n = 1,487,838). Cannabis was associated with a 71% increased risk of AAs (95% CI 1.1-2.6, P = .01). Factors associated with further increased AA risk included concomitant drug use (OR 1.91, 95% CI 1.1-3.5, P = .03) and consumption in cannabis-legal countries (OR 1.93, 95% CI 1.1-3.5, P = .03).

Cannabis use was associated with a 71% increased risk of AAs. A significant paucity of research in non-Western and teenage populations comprise key areas for future research to better inform public health and legalization policies.