{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T01:16:23Z","timestamp":1788916583041,"version":"build-2803163510"},"reference-count":36,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T00:00:00Z","timestamp":1778803200000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"name":"National Heart, Lung, and Blood Institute at the National Institute of Health","award":["U54HL147127"],"award-info":[{"award-number":["U54HL147127"]}]},{"name":"US Food and Drug Administration Center for Tobacco Products"},{"name":"Elfenworks Foundation"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Ultrasonic vaping devices like SURGE are marketed as safer alternatives to conventional coil-based electronic cigarettes like JUUL due to their lower operating temperatures. However, their impact on cardiovascular health has not been fully characterized.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Sprague\u2013Dawley rats were exposed daily for 9\u00a0weeks to aerosol generated from SURGE, JUUL, or clean air. Heart rate variability was continuously monitored via implanted telemetry. Cardiac fibrosis was quantified using histological analysis. Temperature profiles of SURGE, JUUL, and Nautilus (a coil-based tank device) were recorded. Aerosol samples were analyzed for carbonyl compounds using high-performance liquid chromatography.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Both SURGE and JUUL exposures significantly reduced heart rate variability (high frequency and total power) compared with air. JUUL exposure significantly increased cardiac fibrosis; SURGE showed a similar mean fibrosis level but greater variability, resulting in a non-significant difference. SURGE devices operated at lower peak temperatures (~131\u00b0C) than JUUL (~239\u00b0C) and Nautilus (~160\u2013170\u00b0C). Despite having the lowest temperature, SURGE emitted higher levels of carbonyl compounds than JUUL, although still substantially lower than Nautilus.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Although SURGE operates without coils and at lower temperatures than coiled vaping devices, it generates higher levels of carbonyls than some coiled devices and impairs cardiac autonomic regulation, and it can cause cardiac fibrosis comparable with JUUL although with high variability; that is, SURGE does not reliably avoid the increase in fibrosis caused by conventional electronic cigarettes. These findings suggest that non-thermal mechanisms predominate in mediating cardiovascular toxicity associated with ultrasonic vaping, challenging the assumption that coil-free designs are inherently safer.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Implications<\/jats:title>\n                    <jats:p>Despite its lower operating temperature and coil-free design, the SURGE ultrasonic vaping device impaired cardiac autonomic function and promoted fibrosis at a mean level comparable to that of JUUL. These findings challenge claims of reduced harm from coil-less vaping technologies and suggest that non-thermal mechanisms may drive toxicity. Regulatory evaluations should consider device emissions and physiological outcomes\u2014not just hardware features. Physicians and policymakers should be aware that coil-less systems may still pose cardiovascular risks, and marketing these devices as inherently safer may mislead users and undermine tobacco harm reduction efforts.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ntr\/ntag102","type":"journal-article","created":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T12:19:02Z","timestamp":1778674742000},"source":"Crossref","is-referenced-by-count":1,"title":["Adverse cardiac effects of ultrasonic vaping devices despite lack of heating coil"],"prefix":"10.1093","author":[{"given":"Natasha","family":"Goyal","sequence":"first","affiliation":[{"name":"Division of Cardiology, University of California, San Francisco , Box 0124, San Francisco, CA 94143, \u00a0","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maansa","family":"Kavuri","sequence":"additional","affiliation":[{"name":"Division of Cardiology, University of California, San Francisco 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Box 0124, San Francisco, CA 94143, \u00a0","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Cheng","sequence":"additional","affiliation":[{"name":"Division of Oral Epidemiology and Dental Public Health, University of California, San Francisco, Box 1361 , San Francisco, CA 94143 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazukiyo","family":"Kumagai","sequence":"additional","affiliation":[{"name":"Environmental Health Laboratory Branch, Center for Laboratory Sciences, California Department of Public Health , 850 Marina Bay Pkwy, Richmond, CA 94804, \u00a0","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6689-8234","authenticated-orcid":false,"given":"Matthew L","family":"Springer","sequence":"additional","affiliation":[{"name":"Division of Cardiology, University of California, San Francisco , Box 0124, San 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