Can electronic cigarettes affect ECG repolarization indices? A systematic review and meta-analysis

Area of Science:

• Cardiology
• Electrophysiology
• Public Health

Background:

• Electronic cigarette (e-cigarette) adoption raises cardiovascular safety concerns, particularly regarding ventricular repolarization.
• Existing evidence on e-cigarettes' impact on ECG-derived repolarization parameters is fragmented, necessitating a comprehensive synthesis.

Purpose of the Study:

• To systematically review and meta-analyze the effects of e-cigarette use on key ventricular repolarization markers.
• To assess the association between e-cigarette consumption and parameters like Tp-e/QTc, Tpe/QT ratio, QT interval, and Tp-e interval.

Main Methods:

• Systematic review and meta-analysis of human studies comparing e-cigarette users with non-smokers.
• Inclusion of studies reporting at least one repolarization parameter (Tp-e/QTc, Tpe/QT, QT, Tp-e) and excluding mixed or marijuana-using populations.
• Utilized random-effects models for pooled analyses across diverse global studies.

Main Results:

• E-cigarette use was linked to significant adverse effects on all evaluated repolarization parameters.
• The Tp-e/QTc ratio showed the most pronounced prolongation (SMD 1.04, p < 0.00001) with minimal heterogeneity (I² = 0%).
• Significant prolongations were observed in QT interval (+8.36 ms) and Tp-e interval (+4.34 ms), with robust statistical significance.

Conclusions:

• E-cigarette use is associated with significant ventricular repolarization alterations, indicating potential arrhythmogenic risks.
• Current evidence, though statistically robust, is based on a limited number of high-quality studies.
• Large-scale, rigorously designed longitudinal studies with standardized methodologies are crucial to confirm findings and assess long-term cardiovascular impacts.