Cannabis Use and the Risk of Arrhythmias: Insights From a Large Retrospective Multicenter Analysis.

INTRODUCTION

Cannabis use is significantly increasing worldwide yet its cardiovascular effects and arrhythmogenic potential remain unclear. As legalization expands, it is critical to understand public health risks and clinical implications. This study evaluates the relationship between cannabis use and the risk of arrhythmias using a large, real-world dataset.

METHODS

This retrospective cohort study utilized deidentified electronic health records from 68 U.S. healthcare organizations within the TriNetX network. A total of 210 817 adult cannabis users were identified and matched 1:1 with 210 817 ibuprofen users using propensity score matching across 17 baseline variables, including demographics, cardiovascular risk factors, and medication use. The primary outcomes were incident diagnoses of atrial fibrillation/flutter (AF/AFL), paroxysmal tachycardia, premature beats, and ventricular tachycardia/fibrillation (VT/VF). Outcomes were assessed using Cox proportional hazards models and Kaplan-Meier survival analyses.

RESULTS

Cannabis use was significantly associated with an increased risk of multiple arrhythmias compared to ibuprofen use. The incidence of AF/AFL was 1895 versus 1332 cases (HR = 1.549, 95% CI: 1.444-1.662, p < 0.001). Paroxysmal tachycardia occurred in 1065 versus 672 patients (HR = 1.791, 95% CI: 1.626-1.973, p < 0.001), and premature beats in 1135 versus 745 patients (HR = 1.739, 95% CI: 1.585-1.908, p < 0.001). The most pronounced relative risk was observed for VT/VF, with 97 versus 35 cases (HR = 3.078, 95% CI: 2.089-4.533, p < 0.001). All associations remained statistically significant after adjustment, and Kaplan-Meier curves demonstrated lower arrhythmia-free survival in cannabis users across all endpoints.

CONCLUSION

Cannabis use was associated with an increased risk of multiple arrhythmias, particularly atrial fibrillation and ventricular arrhythmias. These findings highlight the need for further research on the cardiovascular effects of cannabis and reinforce the importance of patient counseling regarding its potential arrhythmogenic risks.