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We suggest that clinically relevant NAI-induced bradycardia and arrhythmia are primarily due to SA block and AV block while dominated by supraventricular escape rhythm, signs consistent with elevated vagal tone

This effect was not instantaneous but grew progressively, from -7.6 packs in 1989 to -26.4 packs by 1999 consistent with cumulative behavioral change as anti-smoking campaigns took hold and social norms shifted