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

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.