Short-term ambient air pollution exposure and risk of atrial fibrillation in patients with intracardiac devices

Abstract

Introduction: Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with substantial morbidity and mortality. Short-term exposure to fine particulate matter (PM 2.5 ) has been causally linked to higher risk of cardiovascular disease, but the association with atrial fibrillation (AF) is less clear. Methods: We conducted a time-stratified case-crossover study to estimate the association between short-term air pollution levels and risk of AF episodes. The episodes were identified among patients with paroxysmal AF and an intracardiac devices able to register and store AF episodes. We obtained air pollution and temperature data from fixed monitoring stations and used conditional logistic regression to quantify the association of PM 2.5 , particulate matter (PM 10 ), nitrogen dioxide (NO 2 ) and ozone (O 3 ) with onset of AF episodes, adjusting for temperature and public holidays.”. Results: We analyzed 584 episodes of AF from 91 participants and observed increased risk of AF episodes with PM 2.5 levels for the 48–72 hours lag (OR 1.05; CI [1.01,1.09] per IQR)] and 72–96 hours (OR 1.05 CI [1.00,1.10] per IQR). Our results were suggestive of an association between O 3 levels and AF episodes during the warm season. We did not observe any statistically significant associations for PM 10 nor NO 2 . Conclusion: Short-term increases in PM 2.5 in a low-pollution level environment were associated with increased risk of AF episodes in a population with intracardiac devices. Our findings add to the evidence of a potential triggering of AF by short-term increases in air pollution levels, well below the new WHO air quality guidelines.

Hourly air pollution exposure and the onset of symptomatic arrhythmia: an individual-level case–crossover study in 322 Chinese cities

“…Previous findings on the association of air pollutants with arrhythmia have been mixed. 24 , 26 , 47 , 48 Most studies were subject to the ecological fallacy (the bias that may occur when associations that exist between variables at the aggregate level may not represent the true associations that exist at the individual level), 49 , 50 and were limited in sample size, geographical coverage and time specification. 21 , 23 , 24 , 26 Our case–crossover study strengthens previous findings by providing large-scale, individual-level evidence.…”

“…The inconsistency of these findings may be explained by the difference in air pollution mixture, climate conditions and population susceptibility, as well as the study design, statistical power and exposure lags that were used in the various studies. 21 , 47 , 48 …”

“…Some previous studies linking short-term air pollution exposure and arrhythmia have reported comparable effect sizes to our study. 21 , 24 , 47 , 48 For example, Halldorsdottir and colleagues 21 conducted a time-stratified, case–crossover study in Reykjavik, and found that an increase in NO 2 of 10 μg/m 3 increased the risk of atrial fibrillation at a lag period of 0 days (odds ratio [OR] 1.03, 95% CI 1.01 to 1.05). Another study observed that an IQR increase in PM 2.5 levels was associated with an increased risk of atrial fibrillation (OR 1.05, 95% CI 1.01 to 1.09) at a lag of 48–72 hours.…”

“…As with most previous epidemiological studies on short-term health effects of air pollution, 29 , 48 we obtained all exposure data from fixed site monitors nearest to the reporting hospitals; consequently, errors in exposure measurement were inevitable. However, the patients in our study were usually taken to the nearest hospital for timely treatment, and the resultant non-differential misclassification could only cause Berkson bias, which would not influence the mean estimates of the associations but could lead to an inflation of confidence intervals.…”

Environmental Exposome and Atrial Fibrillation: Emerging Evidence and Future Directions

“…For example, a time-stratified case-crossover study observed an increased risk of AF episodes with PM 2.5 levels. 37 A Chinese study found a 3.1% increased odds ratio of AF for every 10 µg/m³ increase in long-term PM 2.5 exposure. 38 Additionally, a Taiwanese report revealed a positive association between elevated PM 2.5 levels and the emergence of new AF cases.…”