Arrhythmias and cannabis use: A comprehensive overview

Abstract

The increasing prevalence of cannabis use, with an estimated 219 million users globally, underscores the need to examine its potential health impacts. This review focuses on the arrhythmogenic properties of cannabis, particularly considering its active component, tetrahydrocannabinol, and its interactions with the endocannabinoid system. Epidemiological data and multiple studies indicate a significant association between cannabis use and various arrhythmias, particularly atrial fibrillation. The risk is notably higher among younger users and males. Additionally, case reports have linked cannabis use to other arrhythmias such as ventricular tachycardia and ventricular fibrillation, especially in individuals with underlying cardiac abnormalities. This review also discusses the arrhythmogenic potential of synthetic cannabinoids, which are more potent than natural tetrahydrocannabinol. Despite some studies suggesting no significant difference in arrhythmia burden between cannabis users and nonusers, the preponderance of evidence supports a correlation between cannabis use and increased arrhythmia risk. Given the rising tetrahydrocannabinol content in cannabis products and the limited data on the long-term cardiovascular effects, this review underscores the need for large-scale prospective studies. Until more comprehensive data are available, it is advisable for patients with channelopathies, structural heart disease, or prior myocardial infarction to avoid cannabis use.

Keywords: Arrhythmia; Atrial fibrillation; Cannabis; Marijuana; Tetrahydrocannabinol; Ventricular fibrillation/tachycardia.

Figure 1

Pathophysiology of arrhythmia with cannabis use.