Abstract 14753: Cigarette Smoking is Acutely Associated With Increased Cardiac Arrhythmias

Background: Chronic cigarette smoking is a known risk factor for the eventual development of atrial fibrillation (AF). However, the acute effects of cigarette smoking on arrhythmias in patients with AF have not been elucidated.

Methods/Approaches: We conducted a prospective observational study enrolling consenting adults with a diagnosis of paroxysmal AF and who actively smoked. Participants were equipped with continuously recording ECG devices (iRhythm, San Francisco, CA) for up to 14 days and used a smart lighter (Quitbit, San Francisco, CA or Slighter, Cary, NC) or button presses on the ECG device to time-stamp cigarette smoking events in real-time. Outcomes included any AF, atrial flutter (AFL), supraventricular tachycardia (SVT), ventricular tachycardia (VT), atrial ectopic rhythms (EAR), and ventricular bigeminy and trigeminy. For this case-crossover study, we used a generalized linear mixed model with a Poisson distribution and accounted for the clustering of repeated measures for each participant to estimate the incidence rate ratio (IRR) between arrhythmias and smoking events.

Results: We enrolled 29 participants (45% female, mean 55 ± 13 years old, 76% non-Hispanic white), where 22 used a smart lighter, and 7 relied on real-time button presses to document smoking events. Mean study duration was 12 ± 4 days. While wearing the monitor, 24 participants experienced ≥ 1 arrhythmia, including AF (n = 3), SVT (n = 19), VT (n= 5), EAR (n = 23), and ventricular bigeminy/trigeminy (n =12), and 9 participants had ≥ 1 sustained arrhythmia (arrhythmic events >30 secs). Every additional cigarette smoked per day was associated with a 6% increase in arrhythmia events (IRR 1.06, 95% CI 1.05-1.07, P < 0.001; Figure ). No statistically significant relationships were observed between smoking events and sustained arrhythmias per day.

Conclusion: The data suggest smoking acutely increases the chance an arrhythmia will occur.