Clinical Research
Heart Rhythm Disorders
Acute Exposure to Air Pollution Triggers Atrial Fibrillation

https://doi.org/10.1016/j.jacc.2013.05.043Get rights and content
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Objectives

This study sought to evaluate the association of air pollution with the onset of atrial fibrillation (AF).

Background

Air pollution in general and more specifically particulate matter has been associated with cardiovascular events. Although ventricular arrhythmias are traditionally thought to convey the increased cardiovascular risk, AF may also contribute.

Methods

Patients with dual chamber implantable cardioverter-defibrillators (ICDs) were enrolled and followed prospectively. The association of AF onset with air quality including ambient particulate matter <2.5 μm aerodynamic diameter (PM2.5), black carbon, sulfate, particle number, NO2, SO2, and O3 in the 24 h prior to the arrhythmia was examined utilizing a case-crossover analysis. In sensitivity analyses, associations with air pollution between 2 and 48 h prior to the AF were examined.

Results

Of 176 patients followed for an average of 1.9 years, 49 patients had 328 episodes of AF lasting ≥30 s. Positive but nonsignificant associations were found for PM2.5 in the prior 24 h, but stronger associations were found with shorter exposure windows. The odds of AF increased by 26% (95% confidence interval: 8% to 47%) for each 6.0 μg/m3 increase in PM2.5 in the 2 h prior to the event (p = 0.004). The odds of AF were highest at the upper quartile of mean PM2.5.

Conclusions

PM was associated with increased odds of AF onset within hours following exposure in patients with known cardiac disease. Air pollution is an acute trigger of AF, likely contributing to the pollution-associated adverse cardiac outcomes observed in epidemiological studies.

Key Words

air pollution
atrial fibrillation
particulate matter
traffic

Abbreviations and Acronyms

AF
atrial fibrillation
BC
black carbon
CI
confidence interval
EPA
Environmental Protection Agency
ICD
implantable cardioverter-defibrillator
PM2.5
particulate matter <2.5 μm aerodynamic diameter
PNC
particle number count

Cited by (0)

Funding was obtained from NIEHS Grants PO1 ES009825 and P30 ES000002 and the EPA-Harvard Clean Air Research Center (R83479801). These grants partially supported Drs. Luttmann-Gibson, Schwartz, Mittleman, Gold, Dockery, and Laden. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.