Cannabis Can Unmask Hidden Heart Rhythm Disorders and Trigger Fatal Arrhythmias

Cannabinoids affect calcium and potassium currents through both receptor-dependent and -independent pathways, alter autonomic regulation, and promote oxidative stress and inflammation in heart tissue. Genetic variants in SCN5A, KCNH2, KCNQ1, RYR2, and NOS1AP can create subclinical vulnerabilities that become lethal when combined with cannabinoid-induced electrical disruptions, especially from high-potency synthetic cannabinoids.

Meta-narrative review consolidating molecular, clinical, epidemiological, and forensic evidence linking cannabinoid exposure to arrhythmias and sudden cardiac death, including analysis of genetic risk factors.

Most cannabis safety discussions focus on mental health or respiratory effects. This review highlights an underappreciated cardiovascular risk, particularly for people with undiagnosed genetic heart conditions who may not know they are at elevated risk.

The review advocates for a paradigm shift toward personalized risk assessment, combining genetic screening, ECG monitoring, and controlled cannabinoid dosing. While rare, cannabinoid-triggered cardiac events in genetically susceptible individuals represent a preventable cause of sudden death.

Narrative review without systematic methodology. Many findings based on case reports and forensic analyses. Prevalence of cannabinoid-triggered cardiac events is unknown. Genetic testing is not widely available or standardized for this purpose.