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

David M Chye; Thalys Sampaio Rodrigues; Levindo J G Quarto; Naomie Young; Garry W Hamilton; Louise M Burrell; Andrew W Teh; Han S Lim; Anoop N Koshy

doi:10.1016/j.hrthm.2025.05.062

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

Heart Rhythm. 2025 Jun 3:S1547-5271(25)02523-8. doi: 10.1016/j.hrthm.2025.05.062. Online ahead of print.

Authors

David M Chye¹, Thalys Sampaio Rodrigues², Levindo J G Quarto³, Naomie Young⁴, Garry W Hamilton⁵, Louise M Burrell², Andrew W Teh⁶, Han S Lim⁵, Anoop N Koshy⁷

Affiliations

¹ Department of Cardiology, Austin Health, Melbourne, Australia; Department of General Medicine, Austin Health, Melbourne, Australia.
² Department of Cardiology, Austin Health, Melbourne, Australia; Department of General Medicine, Austin Health, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia.
³ Department of Cardiology, Elizabeth Hospital, Boston, Massachusetts.
⁴ Department of General Medicine, Austin Health, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia.
⁵ Department of Cardiology, Austin Health, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia.
⁶ Department of Cardiology, Austin Health, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia; Eastern Health Clinical School, Monash University, Melbourne, Australia.
⁷ Department of Cardiology, Austin Health, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia; Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Australia. Electronic address: anoop.koshy@mh.org.au.

PMID: 40472951
DOI: 10.1016/j.hrthm.2025.05.062

Abstract

Background: 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).

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

Methods: 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).

Results: 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).

Conclusion: 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.

Keywords: Cardiac arrhythmia; Cardiovascular risk; Endocannabinoid system; Epidemiology; Marijuana consumption; Systematic review.