Abstract
Several epidemiological studies found an association between acute exposure to fine particulate matter of less than 2.5 μm and 10 μm in aerodynamic diameter (PM2.5 and PM10) and cardiovascular diseases, ventricular fibrillation incidence and mortality. The effects of pollution on atrial fibrillation (AF) beyond the first several hours of exposure remain controversial. A total of 145 patients with implantable cardioverter-defibrillators (ICDs), cardiac resynchronization therapy defibrillators (ICD-CRT), or pacemakers were enrolled in this multicentric prospective study. Daily levels of PM2.5 and PM10 were collected from monitoring stations within 20 km of the patient’s residence. A Firth Logistic Regression model was used to evaluate the association between AF and daily exposure to PM2.5 and PM10. Exposure levels to PM2.5 and PM10 were moderate, being above the World Health Organization (WHO) PM2.5 and PM10 thresholds of 25 μg/m3 and 50 μg/m3, respectively, on 26% and 18% of the follow-up days. An association was found between daily levels of PM2.5 and PM10 and AF (95% confidence intervals (CIs) of 1.34–2.40 and 1.44–4.28, respectively) for an increase of 50 µg/m3 above the WHO threshold. Daily exposure to moderate PM2.5 and PM10 levels is associated with AF in patients who are not prone to AF.
Highlights
The effects of air pollution on overall mortality and on cardiovascular mortality have been well documented [1,2]
Results are represented as Odds Ratio (OR) and relative 95% Confidence Interval (CI) for an increase in the pollutant concentration of 50 μg/m3 over the World Health Organization (WHO) threshold
A total of 145 patients living in 137 municipalities of the Veneto region were included in the study cohort
Summary
The effects of air pollution on overall mortality and on cardiovascular mortality have been well documented [1,2]. Particulate matter has been linked to an increased risk of myocardial infarction [3] and ventricular fibrillation [4], whereas its relationship with atrial fibrillation (AF) has not been completely clarified yet. In the last two decades, some epidemiological studies evaluated the association between short-term exposure to air pollution and AF with two main approaches: analyzing hospital admissions [9,10,11,12] or enrolling subjects for whom continuous monitoring of the heart rhythm was possible (i.e., patients with implantable devices or subjects that underwent a Holter screening) [13,14,15]. In a healthy community-dwelling sample of nonsmokers, AF predictors were found to be associated with increased levels of PM2.5 [17], and lagged alterations in the ECG were found in association with PM2.5 in patients undergoing catheterization [15]
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