The Prevalence of Cannabis-related Arrhythmias in Patients with Cancer: Real-world Data Evidence of Patient-reported Outcomes

Background: Cannabis consumption is suspected of causing arrhythmias and potentially sudden death. Objectives: To investigate prevalence and temporal relation-ships between cannabis use and onset of symptomatic arrhythmias among cancer patients using Belong. life, a digital patient powered network application.Methods: Real-world data (RWD) were obtained through Belong. Life, a mobile application for cancer patients who use cannabis routinely. Patients replied anonymously and voluntarily to a survey describing their demographics, medical history, and cannabis use.Results: In total, 354 cancer patients (77% female, 71% 50-69 years of age) replied: 33% were smokers and 49% had no co-morbidities. Fifteen had history of arrhythmias and two had a pacemaker; 64% started cannabis before or during chemotherapy and 18% had no chemotherapy. Cannabis indication was symptom relief in most patients. The mode of administration included oil, smoking, or edibles; only 35% were prescribed by a doctor. Cannabis type was delta 9-tet-rahydrocannabinol > 15% in 43% and cannabidiol in 31%. After starting cannabis, 24 patients (7%) experienced palpitations; 13 received anti-arrhythmic drugs and 6 received anticoagulation. Eleven needed further medical investigation. Three were hospitalized. One had an ablation after starting cannabis and one stopped cannabis due to palpitations. Seven patients (2%) reported brady-arrhythmias after starting cannabis, but none needed pacemaker implantation.Conclusions: RWD showed that in cancer patients using cannabis, the rate of reported symptomatic tachy-and brady-arrhythmias was significant (9%) but rarely led to invasive treatments. Although direct causality cannot be proven, temporal relationship between drug use and onset of symptoms suggests a strong association.