Evaluating ECG and carboxyhemoglobin changes due to smoking narghile

Abstract

Purpose: This study aimed to investigate whether increased carboxyhemoglobin (COHB) levels and ECG changes, which associated with fatal ventricular dysrhythmias, including increased QT, P-wave and T peak (Tp)-Tend (Te) dispersion, can be detected after smoking narghile, which is a traditional method of smoking tobacco that is smoked from hookah device.

Materials and methods: After local ethics committee approval, this prospective study was conducted using healthy volunteer subjects at a “narghile café,” which is used by people smoking narghile in an open area. Before beginning to smoke narghile, all subjects’ 12-lead electrocardiographs (ECG), measurements of COHB levels, and vital signs were recorded. After smoking narghile for 30 min, the recording of the 12-lead ECGs and the measurements of COHB level and all vital signs were repeated.

Results: The mean age of subjects was 26.8 ± 6.2 years (min-max: 18–40), and 28 subjects (84.8%) were male. Before smoking narghile, the median value of subjects’ COHB levels was 1.3% (min-max: 0–6), whereas after smoking, the median value of COHB was 23.7% (min-max: 6–44), a statistically significant increase (p < 0.001). Analysis of the subjects’ ECG changes after smoking narghile showed that dispersions of QT, QTc, P-wave and Tp-Te were increased, and all changes were statistically significant (p < 0.001 for all parameters).

Conclusion: Although, especially among young people, it is commonly thought that smoking narghile has less harmful or toxic effects than other tobacco products. The results of this study and past studies clearly demonstrated that smoking narghile can cause several ECG changes - including increased QT, P-wave and Tp-Te dispersion - which can be associated with ventricular dysrhythmias.

Keywords:

• Carbon monoxide
• P wave dispersion
• QT/QTc dispersion
• smoking narghile
• Tpeak-Tend dispersion

Declaration of interest

The authors declare that there are no conflicts of interest.