Lack of correlation between air pollution and acute-onset atrial fibrillation

Environmental Exposome and Atrial Fibrillation: Emerging Evidence and Future Directions

There has been increased awareness of the linkage between environmental exposures and cardiovascular health and disease. Atrial fibrillation is the most common sustained cardiac arrhythmia, affecting millions of people worldwide and contributing to substantial morbidity and mortality. Although numerous studies have explored the role of genetic and lifestyle factors in the development and progression of atrial fibrillation, the potential impact of environmental determinants on this prevalent condition has received comparatively less attention. This review aims to provide a comprehensive overview of the current evidence on environmental determinants of atrial fibrillation, encompassing factors such as air pollution, temperature, humidity, and other meteorologic conditions, noise pollution, greenspace, and the social environment. We discuss the existing evidence from epidemiological and mechanistic studies, critically evaluating the strengths and limitations of these investigations and the potential underlying biological mechanisms through which environmental exposures may affect atrial fibrillation risk. Furthermore, we address the potential implications of these findings for public health and clinical practice and identify knowledge gaps and future research directions in this emerging field.

The association between air pollution and the daily hospital visits for atrial fibrillation recorded by ECG: a cross-sectional study

BACKGROUND

The relationship between air pollution and atrial fibrillation (AF) recorded by electrocardiograph (ECG) has not yet been illustrated which worsens AF precaution and treatment. This research evaluated the association between air pollution and daily hospital visits for AF with ECG records.

METHODS

The study enrolled 4933 male and 5392 female patients whose ECG reports indicated AF from 2015 to 2018 in our hospital. Such data were then matched with meteorological data, including air pollutant concentrations, collected by local weather stations. A case-crossover study was performed to assess the relationship between air pollutants and daily hospital visits for AF recorded by ECG and to investigate its lag effect.

RESULTS

Our analysis revealed statistically significant associations between AF occurrence and demographic data, including age and gender. This effect was stronger in female (k = 0.02635, p < 0.01) and in patients over 65 y (k = 0.04732, p < 0.01). We also observed a hysteretic effect that when exposed to higher nitrogen dioxide(NO2), counting AF cases recorded by ECG may elevate at lag 0 with a maximum odds ratio(OR) of 1.038 (95% CI 1.014-1.063), on the contrary, O3 reduced the risk of daily visits for AF and its maximum OR was at lag 2, and the OR value was 0.9869 (95% CI 0.9791-0.9948). Other air pollutants such as PM2.5, PM10, and SO2 showed no clear relationship with the recorded AF.

CONCLUSION

The associations between air pollution and AF recorded with ECG were preliminarily discovered. Short-term exposure to NO2 was significantly associated with daily hospital visits for AF management.

Association between Air Pollution and Emergency Room Visits for Atrial Fibrillation

Despite the large prevalence in the population, possible factors responsible for the induction of atrial fibrillation (AF) events in susceptible individuals remain incompletely understood. We investigated the association between air pollution levels and emergency department admissions for AF in Rome. We conducted a 14 years’ time-series study to evaluate the association between the daily levels of air pollution (particulate matter, PM₁₀ and PM_2.5, and nitrogen dioxide, NO₂) and the daily count of emergency accesses for AF (ICD-9 code: 427.31). We applied an over-dispersed conditional Poisson model to analyze the associations at different lags after controlling for time, influenza epidemics, holiday periods, temperature, and relative humidity. Additionally, we evaluated bi-pollutant models by including the other pollutant and the influence of several effect modifiers such as personal characteristics and pre-existing medical conditions. In the period of study, 79,892 individuals were admitted to the emergency departments of Rome hospitals because of AF (on average, 15.6 patients per day: min = 1, max = 36). Air pollution levels were associated with increased AF emergency visits within 24 h of exposure. Effect estimates ranged between 1.4% (0.7–2.3) for a 10 µg/m³ increase of PM₁₀ to 3% (1.4–4.7) for a 10 µg/m³ increase of PM_2.5 at lag 0–1 day. Those effects were higher in patients ≥75 years for all pollutants, male patients for PM₁₀, and female patients for NO₂. The presence of previous cardiovascular conditions, but not other effect modifiers, increase the pollution effects by 5–8% depending on the lag. This study found evidence that air pollution is associated with AF emergency visits in the short term.

Association between air pollution and development of atrial fibrillation: A meta-analysis of observational studies

BACKGROUND

Current evidence suggests that gaseous or particulate pollutants may increase the risk of atrial fibrillation (AF), although this association is still uncertain.

METHODS

We conducted a systematic review of literature using PubMed, Ovid, Embase and Web of Science to identify studies reporting on the association between gaseous (ozone, carbon monoxide, sulfur dioxide, and nitrogen dioxide) or particulate matter 2.5 (PM2.5) and AF risk published until March 2015. The overall effect estimate was presented as the population-attributable risks with 95% CI. We used both fix-effects and random effects models to calculate the overall effect estimate.

RESULTS

We retrieved 4 studies, involving 461,441 participants. There was a statistically significant association between AF development and all gaseous pollutant as well as PM_2.5 [NO: 1.19% (0.70-1.67%), CO: 0.60 (0.20-1.09), SO₂: 0.90 (0.60-1.28), O₃: 1.09 (0.20-1.86), PM_2.5: 0.89 (0.20-1.57)].

CONCLUSIONS

Our comprehensive meta-analysis suggests that gaseous or particulate pollutants are associated with the increased risk of AF.

Incidence of acute-onset atrial fibrillation correlates with air temperature. Results of a nine-year survey

Some diseases, such as renal colic, stroke, and myocardial infarction, correlate with seasonality and microclimatic variations. Although evidence is limited and controversial, a correlation between acute-onset atrial fibrillation (AAF) and seasonality has been previously reported. In order to elucidate the possible correlations between weather and incidence of AAF in a country with a temperate climate, the influence of day-by-day climate changes was analyzed based on the number of visits for AAF (defined as onset of symptoms within 48 h) in a large urban Emergency Department (ED) of northern Italy. All the episodes of AAF were retrieved from the hospital’s electronic database during a period of 3287 days (January 2002 to December 2010). Only the cases whose onset occurred within 48 h from the ED visit were selected. The total number of ED visits was 725,812 throughout the observational period. Among these, 3633 AAF cases were observed, 52% of which were males. A slight but significant negative linear correlation was found between the number of AAFs and the daily temperature (R = −0.60; p = 0.001). No correlation was found between the number of AAFs and the daily humidity (R = −0.07; p = 0.2).