Continuing Medical Education, University of Colorado Boulder, Boulder, Colorado, USA.
Department of Medicine, Northwestern University School of Medicine, Chicago, Illinois, USA.
Cannabis Cannabinoid Res. 2023 Oct;8(5):867-876. doi: 10.1089/can.2021.0188. Epub 2022 Mar 29.
Cannabis use is increasing worldwide, especially among older individuals at risk for chronic ischemic heart disease (IHD). However, little is known about the arrhythmic effects of cannabis use in IHD. Accordingly, we prospectively assessed the relationship between cannabis use, heart rate (HR), and arrhythmias in healthy age-matched controls and subjects with IHD. Healthy controls (=37, 57% men) and subjects with IHD (myocardial infarction ≥3 months ago; =24, 58% men) who used cannabis wore a Zio (iRhythm Technologies) monitor for 14 days. Noncannabis using ischemic subjects (=35, 51% males) wore Zio monitors for standard clinical indications. Baseline HR was compared with average HR measured for 4 h following consumption and changes in HR and frequency of arrhythmias were correlated with cannabis use. In controls, HR increased 20 min (4.99±6.7 bpm, =0.08) after use, then declined 4 h following use (-7.4±7.7, <0.001). Conversely, subjects with IHD showed minimal HR increase (1.6±3.9 bpm) and blunted HR decline (-3.4±5.6 bpm, <0.001). Supraventricular tachycardia (SVT) (29.7% vs. 58.3%; =0.04) and nonsustained ventricular tachycardia (NSVT) (5.6% vs. 47.8%, =0.01) were the most frequently occurring arrhythmias in controls and IHD subjects, respectively. Incidence of SVT decreased as cannabis use increased in both groups. Conversely, NSVT tended to increase with increased use in controls, and was significantly more prevalent in IHD. However, overall arrhythmia burden did not differ between cannabis users and nonusers with IHD. Our findings demonstrate that chronic cannabis use is associated with only mild HR changes, which are blunted in IHD. In addition, our data suggest that among cannabis users, arrhythmias are more frequent in IHD subjects that in healthy subjects.
大麻使用在全球范围内呈上升趋势，尤其是在有患慢性缺血性心脏病（IHD）风险的老年人中。然而，关于大麻使用对 IHD 的心律失常影响知之甚少。因此，我们前瞻性地评估了大麻使用与健康年龄匹配的对照组和 IHD 患者的心率（HR）和心律失常之间的关系。 佩戴 Zio（iRhythm Technologies）监测器 14 天的健康对照组（=37，57%男性）和 IHD 患者（心肌梗塞≥3 个月；=24，58%男性）。未使用大麻的缺血性患者（=35，51%男性）佩戴 Zio 监测器进行标准临床指征监测。比较基线 HR 与使用后 4 小时平均 HR 的变化，并将 HR 变化和心律失常频率与大麻使用相关联。 在对照组中，使用后 20 分钟 HR 增加 20 分钟（4.99±6.7 bpm，=0.08），然后在使用后 4 小时下降（-7.4±7.7 bpm，<0.001）。相反，IHD 患者的 HR 增加幅度最小（1.6±3.9 bpm），HR 下降幅度变钝（-3.4±5.6 bpm，<0.001）。室上性心动过速（SVT）（29.7%比 58.3%；=0.04）和非持续性室性心动过速（NSVT）（5.6%比 47.8%，=0.01）分别是对照组和 IHD 患者中最常见的心律失常。在两组中，随着大麻使用量的增加，SVT 的发生率均降低。相反，NSVT 在对照组中随着使用量的增加而增加，在 IHD 中更为常见。然而，IHD 患者中，大麻使用者与非使用者的心律失常总负担并无差异。 我们的研究结果表明，慢性大麻使用仅与轻微的 HR 变化相关，而在 IHD 中则变钝。此外，我们的数据表明，在大麻使用者中，心律失常在 IHD 患者中比在健康人群中更为常见。
