The environmental epidemiology of atrial arrhythmogenesis

Abstract

Atrial fibrillation (AF) is the most common cardiac arrhythmia seen in clinical practice and as a potent risk factor for heart failure and stroke, it makes an important contribution to cardiovascular disease (CVD) and all-cause mortality. Its large and increasing population burden has prompted a recent shift in the focus of AF research, from that concentrating on its treatments and complications, to the evaluation of its putative risk factors including ambient air pollution, the topic of this review. Although the review pertains specifically to AF, much of its content is drawn from and therefore applicable to the study of other arrhythmias, the conduct of which is confronted by many of the same challenges. Meeting these challenges involves recognizing the collective importance of 1) large, ethnically and geographically diverse, clinically well-characterized populations; 2) methods for reducing uncertainty in outcome ascertainment, distinguishing effects of pervasive environmental exposures, and improving their estimation; 3) approaches to evaluation of susceptibility; as well as 4) strategies for informing regulatory policies designed to help control population-level risks for CVD.

Hydrogen sulphide increases pulmonary veins and atrial arrhythmogenesis with activation of protein kinase C

“…Air pollutants may trigger the occurrence of AF via direct and/or indirect effects on the atrial myocardium. 49 In this study, we found that H 2 S has direct electrophysiological effects on AF substrates and triggers, supporting that H 2 S may contribute to air pollution-induced AF at least in part. However, simply investigating H 2 S may not fully uncover the mechanisms of polluted airinduced PV and atrial arrhythmogenesis as air pollution contains multiple pollutants in addition to H 2 S. In addition, this study found that chelerythrine or rottlerin had inhibitory effects on NaHS-induced arrhythmogenesis, and NaHS-treated atrium had larger PKC activity than those without treatment, suggesting that PKC pathway plays a crucial role in H 2 S-mediated arrhythmogenesis.…”

“…This study should be interpreted with cautions due to the potential limitations. Air pollutants may trigger the occurrence of AF via direct and/or indirect effects on the atrial myocardium . In this study, we found that H 2 S has direct electrophysiological effects on AF substrates and triggers, supporting that H 2 S may contribute to air pollution‐induced AF at least in part.…”

Association between Air Pollution and Emergency Room Visits for Atrial Fibrillation

“…Recent studies also suggested the possible association of air pollution exposure with atrial fibrillation (AF), the most frequent cardiac arrhythmia diagnosed in clinical practice [ 13 ]. The prevalence of AF in the general population increases with age, being around 1% or less in adults younger than 60 years and reaching >9% in patients aged 80 or older [ 14 , 15 ].…”

Fine Particulate Air Pollution is Associated with Higher Vulnerability to Atrial Fibrillation—the Apacr Study

“…Several studies suggested an association between ambient air pollution and atrial fibrillation/flutter (AF) ( Rich et al, 2006 ), stroke, and cardiovascular disease (CVD) ( Miller et al, 2007 ; Pope et al, 2004 ), but the impact of air pollution on AF risk may have been underestimated ( Whitsel and Avery, 2010 ). Approximately 4% of U.S. adults aged 60 yr or more have been diagnosed with AF ( Go et al, 2001 ).…”