Increased Risk of Paroxysmal Atrial Fibrillation Episodes Associated with Acute Increases in Ambient Air Pollution

By Rich, David Q.; Mittleman, Murray A. et al. | Environmental Health Perspectives, January 2006 | Go to article overview

Increased Risk of Paroxysmal Atrial Fibrillation Episodes Associated with Acute Increases in Ambient Air Pollution


Rich, David Q., Mittleman, Murray A., Link, Mark S., Schwartz, Joel, Luttmann-Gibson, Heike, Catalano, Paul J., Speizer, Frank E., Gold, Diane R., Dockery, Douglas W., Environmental Health Perspectives


Objectives: We reported previously that 24-hr moving average ambient air pollution concentrations were positively associated with ventricular arrhythmias detected by implantable cardioverter defibrillators (ICDs). ICDs also detect paroxysmal atrial fibrillation episodes (PAF) that result in rapid ventricular rates. In this same cohort of ICD patients, we assessed the association between ambient air pollution and episodes of PAF.

Design: We performed a case--crossover study.

Participants: Patients who lived in the Boston, Massachusetts, metropolitan area and who had ICDs implanted between June 1995 and December 1999 (n = 203) were followed until July 2002.

Evaluations/Measurements: We used conditional logistic regression to explore the association between community air pollution and 91 electrophysiologist-confirmed episodes of PAF among 29 subjects.

Results: We found a statistically significant positive association between episodes of PAF and increased ozone concentration (22 ppb) in the hour before the arrhythmia (odds ratio = 2.08; 95% confidence interval = 1.22, 3.54; p = 0.001). The risk estimate for a longer (24-hr) moving average was smaller, thus suggesting an immediate effect. Positive but not statistically significant risks were associated with fine particles, nitrogen dioxide, and black carbon.

Conclusions: Increased ambient [O.sub.3] pollution was associated with increased risk of episodes of rapid ventricular response due to PAF, thereby suggesting that community air pollution may be a precipitant of these events.

Key words: air pollution, arrhythmias, fibrillation, epidemiology, case--crossover, ozone. Environ Health Perspect 114:120-123 (2006). doi:10.1289/ehp.8371 available via http://dx.doi.org/ [Online 20 September 2005]

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In previous studies, we reported statistically significant associations between ambient air pollution and cardiac arrhythmias in patients with implantable cardioverter defibrillator (ICD) devices (Dockery et al. 2005a, 2005b; Peters et al. 2000b; Rich et al. 2005). A pilot study of 100 patients in Boston, Massachusetts, found significantly increased risk of ICD discharges associated with nitrogen dioxide and black carbon among patients with repeated events (Peters et al. 2000b). In a larger study of approximately 200 Boston-area ICD patients, we found a nonstatistically significant increased risk of ventricular arrhythmias (confirmed by an electrophysiologist) associated with 2-day mean N[O.sub.2], particulate matter < 2.5 [micro]m in aerodynamic diameter (P[M.sub.2.5]), black carbon, carbon monoxide, ozone, and sulfur dioxide (Dockery et al. 2005a, 2005b). In a case-crossover analysis of these data, which allowed us to match the time of onset of these arrhythmias with ambient air pollution concentrations, we found stronger, statistically significant associations of ventricular arrhythmias with mean P[M.sub.2.5] and [O.sub.3] in the 24 hr before the arrhythmia (Rich et al. 2005).

Although ICDs are designed to detect and treat life-threatening ventricular arrhythmias, supraventricular arrhythmias may also be detected. Many of these supraventricular arrhythmias may be atrial fibrillation, which is the most common sustained arrhythmia in clinical practice (Go et al. 2001) and a risk factor for stroke (Prystowsky et al. 1996) and premature mortality (Kanel et al. 1983). We used a case--crossover design to examine the association of ICD-detected paroxysmal atrial fibrillation and hourly measurements of community air pollution concentrations.

Materials and Methods

Study population. Two hundred three patients who had a third-generation Guidant ICD (Cardiac Pacemakers, Inc., Minneapolis, MN) implanted at the Tufts--New England Medical Center between 1 June 1995 and 31 December 1999, were followed until their last clinic visit before 15 July 2002. Patients who lived within 40 km (25 mi) of the air pollution monitoring station at the Harvard School of Public Health were included for analysis. …

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