Abstract 16015: Acute Exposure to Air Pollution Triggers Ventricular Arrhythmias
Background: Air pollution has been associated with cardiac events, including sudden cardiac death. However, the temporal association for acute events is not clear. In this prospective study we follow patients with implantable cardioverter defibrillators (ICDs) to assess the acute effects of air pollution on ventricular arrhythmias.
Methods: Subjects were recruited from Tufts Medical Center Arrhythmia Clinic between September 2006 and March 2010. Inclusion criteria included prior implantation of a dual chamber ICD and residential zip codes within a 50-kilometer radius of the Harvard Supersite air quality monitoring station. Arrhythmias documented by the ICD were reviewed and interpreted by an electrophysiologist blinded to air quality. The correlations of sustained ventricular arrhythmias (defined as those necessitating treatment by the ICD) with air pollution, including PM2.5, black carbon (BC), sulfate, particle number, NO2, SO2, and O3 were assessed utilizing a case-crossover design.
Results: 200 patients were enrolled and followed an average of 1.9 years. Patients were 70% male, 93% Caucasian, had a mean age of 65 years, and mean left ventricular ejection fraction of 31.4%. Indications for implantation of an ICD were primary prophylaxis in 111 subjects (63%), secondary prophylaxis in 33 subjects (19%), and syncope which clinically appeared arrhythmic, but without documentation of an arrhythmia in 32 subjects (18%). In 29 patients there were 151 ventricular arrhythmias. Increased levels of PM2.5 at 6, 12, 24 and 48 hour lag times were associated with up to a 37% increased risk of a ventricular arrhythmia (p<0.05). Elevated BC at 12 hour lag time was nearly statistically significant (p=.07) with a 23% increase in risk.
Conclusion: Particulate matter associated with motor vehicular emissions was associated with up to a 37% increased risk of ventricular arrhythmias within hours following exposure in patients with known cardiac disease.
- © 2013 by American Heart Association, Inc.