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Dahlquist M, Frykman V, Hollenberg J, Jonsson M, Stafoggia M, Wellenius GA, Ljungman PLS. Short-Term Ambient Air Pollution Exposure and Risk of Out-of-Hospital Cardiac Arrest in Sweden: A Nationwide Case-Crossover Study. J Am Heart Assoc 2023; 12:e030456. [PMID: 37818697 PMCID: PMC10727387 DOI: 10.1161/jaha.123.030456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 08/22/2023] [Indexed: 10/12/2023]
Abstract
Background Air pollution is one of the main risk factors for cardiovascular disease globally, but its association with out-of-hospital cardiac arrest at low air pollution levels is unclear. This nationwide study in Sweden aims to investigate if air pollution is associated with a higher risk of out-of-hospital cardiac arrest in an area with relatively low air pollution levels. Methods and Results This study was a nationwide time-stratified case-crossover study investigating the association between short-term air pollution exposures and out-of-hospital cardiac arrest using data from the SRCR (Swedish Registry for Cardiopulmonary Resuscitation) between 2009 and 2019. Daily air pollution levels were estimated in 1×1-km grids for all of Sweden using a satellite-based machine learning model. The association between daily air pollutant levels and out-of-hospital cardiac arrest was quantified using conditional logistic regression adjusted for daily air temperature. Particulate matter <2.5 μm exposure was associated with a higher risk of out-of-hospital cardiac arrest among a total of 29 604 cases. In a multipollutant model, the association was most pronounced for intermediate daily lags, with an increased relative risk of 6.2% (95% CI, 1.0-11.8) per 10 μg/m3 increase of particulate matter <2.5 μm 4 days before the event. A similar pattern of association was observed for particulate matter <10 μm. No clear association was observed for O3 and NO2. Conclusions Short-term exposure to air pollution was associated with higher risk of out-of-hospital cardiac arrest. The findings add to the evidence of an adverse effect of particulate matter on out-of-hospital cardiac arrest, even at very low levels below current regulatory standards.
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Affiliation(s)
- Marcus Dahlquist
- Institute of Environmental MedicineKarolinska InstitutetStockholmSweden
- Department of CardiologyDanderyd University HospitalSweden
| | - Viveka Frykman
- Department of CardiologyDanderyd University HospitalSweden
- Department of Clinical SciencesDanderyd University Hospital, Karolinska InstitutetDanderydSweden
| | - Jacob Hollenberg
- Center for Resuscitation Science, Department of Clinical Science and Education, SödersjukhusetKarolinska InstitutetStockholmSweden
| | - Martin Jonsson
- Center for Resuscitation Science, Department of Clinical Science and Education, SödersjukhusetKarolinska InstitutetStockholmSweden
| | - Massimo Stafoggia
- Institute of Environmental MedicineKarolinska InstitutetStockholmSweden
- Department of EpidemiologyLazio Region Health ServiceRoma 1Italy
| | - Gregory A. Wellenius
- Department of Environmental HealthBoston University School of Public HealthMAUSA
| | - Petter L. S. Ljungman
- Institute of Environmental MedicineKarolinska InstitutetStockholmSweden
- Department of CardiologyDanderyd University HospitalSweden
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Miarimbola R, Collart P, Casado-Arroyo R, Coppieters Y. [Air pollution and heart rhythm disturbance: A retrospective study]. Ann Cardiol Angeiol (Paris) 2021; 70:203-209. [PMID: 34274112 DOI: 10.1016/j.ancard.2021.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 06/08/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION According to many studies, exposure to air pollution increases cardiovascular morbidity and mortality. It has also been shown that the frequency of heart rhythm disorders in Region wallonne is very high. OBJECTIVES The objective of this study is to test the hypothesis of a link between rhythm disorders measured by cardiac holters and data from devices measuring the concentration of air pollutants present in ambient air. METHODOLOGY The health data were obtained via the Erasme hospital's cardiology center. This is a retrospective data collection over the last 2 to 5 years. The environmental data are: PM2.5, PM10, NO2, O3 and temperature. The statistical models were based on "cross-case" analyses. RESULTS An association between PM10 and the number of ESAs was observed. An increase of 10μg/m3 of PM10 increases the number of ESAs by 20% (P=0.040). The number of ESAs increases with age (63% more ESAs when age increases by 10 years). A history of intervention also decreases the number of ESAs (-35%), the same phenomenon is observed for pacemaker wearers (-66%). The strongest association observed between NO2 and ESA with an OR of 1.37 (P=0.027) in the final model. No significant association was observed between the effects of air pollution and VPCs. CONCLUSION Our analyses resume the effects of the different pollutants on rhythm disorders, the effects adjusted for treatment and co-morbidities. They open the door to other more refined studies based on individual measurements.
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Affiliation(s)
- R Miarimbola
- Centre de recherche épidémiologie, biostatistiques et recherche clinique, école de santé publique, université libre de Bruxelles (ULB), Route de Lennik 808, CP 596, 1070 Bruxelles, Belgique.
| | - P Collart
- Centre de recherche épidémiologie, biostatistiques et recherche clinique, école de santé publique, université libre de Bruxelles (ULB), Route de Lennik 808, CP 596, 1070 Bruxelles, Belgique
| | - R Casado-Arroyo
- Unité d'électrophysiologie et stimulation cardiaque, CHU Erasme, Bruxelles, Belgique
| | - Y Coppieters
- Centre de recherche épidémiologie, biostatistiques et recherche clinique, école de santé publique, université libre de Bruxelles (ULB), Route de Lennik 808, CP 596, 1070 Bruxelles, Belgique
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Yang M, Zhou R, Qiu X, Feng X, Sun J, Wang Q, Lu Q, Zhang P, Liu B, Li W, Chen M, Zhao Y, Mo B, Zhou X, Zhang X, Hua Y, Guo J, Bi F, Cao Y, Ling F, Shi S, Li YG. Artificial intelligence-assisted analysis on the association between exposure to ambient fine particulate matter and incidence of arrhythmias in outpatients of Shanghai community hospitals. ENVIRONMENT INTERNATIONAL 2020; 139:105745. [PMID: 32334122 DOI: 10.1016/j.envint.2020.105745] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 04/14/2020] [Accepted: 04/14/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Recently, the impact of fine particulate matter pollution on cardiovascular system is drawing considerable concern worldwide. The association between ambient fine particulate and the cardiac arrhythmias is not clear now. OBJECTIVE To study associations of ambient fine particulate with incidence of arrhythmias in outpatients. METHODS Data was collected from the remote electrocardiogram (ECG) system covering 282 community hospitals in Shanghai from June 24th, 2014 to June 23rd, 2016. ECG was performed for patients admitted to above hospitals with complaining of chest discomfort or palpitation, or for regular check-ups. Air quality data during this time period was obtained from China National Environment Monitoring Center. A generalized additive quasi-Poisson model was established to examine the associations between PM2.5 and cardiac arrhythmias. RESULTS Cardiac arrhythmias were detected in 202,661 out of 1,016,579 outpatients (19.9%) and fine particulate matter ranged from 6 to 219 μg/m3 during this period. Positive associations were evidenced between fine particulate matter level and prevalence of cardiac arrhythmia by different lag models. Per 10 μg/m3 increase in fine particulate matter was associated with a 0.584%(95%CI:0.346-0.689%, p < 0.001) increase of cardiac arrhythmia detected in these patient cohort at lag0-2. For different types of cardiac arrhythmias, an immediate arrhythmogenic effect of fine particulate matter (increase of the estimates of cardiac arrhythmia prevalence detected in daily outpatient visits) was found with paroxysmal supraventricular tachycardia; a lag effect was found with atrial fibrillation; and both immediate and lag effect was found with premature atrial contractions or atrial tachycardia, atrioventricular block. Moreover, the impact of fine particulate matter on cardiac arrhythmias was significantly greater in women (lag3 and lag0-4), and in people aged <65 years (lag0). CONCLUSION Ambient exposure to fine particulate matter is linked with increased risk of arrhythmias in outpatients visiting Shanghai community hospitals, with an immediate or lag effect. The arrhythmogenic effect varies among different types of cardiac arrhythmias.
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Affiliation(s)
- Mei Yang
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Runze Zhou
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Department of Cardiology, East Hospital, Tongji University, Shanghai, China
| | | | - Xiangfei Feng
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jian Sun
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qunshan Wang
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qiufen Lu
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Pengpai Zhang
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Bo Liu
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wei Li
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Mu Chen
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yan Zhao
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Binfeng Mo
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xin Zhou
- Clinical Research Unit, Xin Hua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xi Zhang
- Clinical Research Unit, Xin Hua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yingxue Hua
- Pudong New Area Heqing Community Health Center, Shanghai, China
| | - Jin Guo
- Shanghai Huangpu Bund Subdistrict Community Health Center, Shanghai, China
| | - Fangfang Bi
- Changning Tianshan Community Health Center, Shanghai, China
| | - Yajun Cao
- Pudong New Area Sunqiao Community Health Center, Shanghai, China
| | - Feng Ling
- Shanghai Lingyun Community Health Center, Shanghai, China
| | - Shengming Shi
- Shangnail Xinhua Street Community Health Service Center, Shanghai, China
| | - Yi-Gang Li
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
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Carll AP, Salatini R, Pirela SV, Wang Y, Xie Z, Lorkiewicz P, Naeem N, Qian Y, Castranova V, Godleski JJ, Demokritou P. Inhalation of printer-emitted particles impairs cardiac conduction, hemodynamics, and autonomic regulation and induces arrhythmia and electrical remodeling in rats. Part Fibre Toxicol 2020; 17:7. [PMID: 31996220 PMCID: PMC6990551 DOI: 10.1186/s12989-019-0335-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 12/29/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Using engineered nanomaterial-based toners, laser printers generate aerosols with alarming levels of nanoparticles that bear high bioactivity and potential health risks. Yet, the cardiac impacts of printer-emitted particles (PEPs) are unknown. Inhalation of particulate matter (PM) promotes cardiovascular morbidity and mortality, and ultra-fine particulates (< 0.1 μm aerodynamic diameter) may bear toxicity unique from larger particles. Toxicological studies suggest that PM impairs left ventricular (LV) performance; however, such investigations have heretofore required animal restraint, anesthesia, or ex vivo preparations that can confound physiologic endpoints and/or prohibit LV mechanical assessments during exposure. To assess the acute and chronic effects of PEPs on cardiac physiology, male Sprague Dawley rats were exposed to PEPs (21 days, 5 h/day) while monitoring LV pressure (LVP) and electrocardiogram (ECG) via conscious telemetry, analyzing LVP and heart rate variability (HRV) in four-day increments from exposure days 1 to 21, as well as ECG and baroreflex sensitivity. At 2, 35, and 70 days after PEPs exposure ceased, rats received stress tests. RESULTS On day 21 of exposure, PEPs significantly (P < 0.05 vs. Air) increased LV end systolic pressure (LVESP, + 18 mmHg) and rate-pressure-product (+ 19%), and decreased HRV indicating sympathetic dominance (root means squared of successive differences [RMSSD], - 21%). Overall, PEPs decreased LV ejection time (- 9%), relaxation time (- 3%), tau (- 5%), RMSSD (- 21%), and P-wave duration (- 9%). PEPs increased QTc interval (+ 5%) and low:high frequency HRV (+ 24%; all P < 0.05 vs. Air), while tending to decrease baroreflex sensitivity and contractility index (- 15% and - 3%, P < 0.10 vs. Air). Relative to Air, at both 2 and 35 days after PEPs, ventricular arrhythmias increased, and at 70 days post-exposure LVESP increased. PEPs impaired ventricular repolarization at 2 and 35 days post-exposure, but only during stress tests. At 72 days post-exposure, PEPs increased urinary dopamine 5-fold and protein expression of ventricular repolarizing channels, Kv1.5, Kv4.2, and Kv7.1, by 50%. CONCLUSIONS Our findings suggest exposure to PEPs increases cardiovascular risk by augmenting sympathetic influence, impairing ventricular performance and repolarization, and inducing hypertension and arrhythmia. PEPs may present significant health risks through adverse cardiovascular effects, especially in occupational settings, among susceptible individuals, and with long-term exposure.
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Affiliation(s)
- Alex P. Carll
- Department of Physiology, School of Medicine, University of Louisville, Louisville, KY USA
- Christina Lee Brown Envirome Institute, University of Louisville, Louisville, KY USA
- Center for Nanotechnology and Nanotoxicology. Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, 665 Huntington Avenue, Room 1310, Boston, MA 02115 USA
| | - Renata Salatini
- Department of Physiology, School of Medicine, University of Louisville, Louisville, KY USA
- Department of Surgery, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Sandra V. Pirela
- Center for Nanotechnology and Nanotoxicology. Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, 665 Huntington Avenue, Room 1310, Boston, MA 02115 USA
| | - Yun Wang
- Center for Nanotechnology and Nanotoxicology. Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, 665 Huntington Avenue, Room 1310, Boston, MA 02115 USA
- Department of Occupational and Environmental Health Sciences,School of Public Health, Peking University, Beijing, People’s Republic of China
| | - Zhengzhi Xie
- Christina Lee Brown Envirome Institute, University of Louisville, Louisville, KY USA
| | - Pawel Lorkiewicz
- Christina Lee Brown Envirome Institute, University of Louisville, Louisville, KY USA
| | - Nazratan Naeem
- Christina Lee Brown Envirome Institute, University of Louisville, Louisville, KY USA
| | - Yong Qian
- Pathology and Physiology Research Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Morgantown, WV USA
| | - Vincent Castranova
- Department of Pharmaceutical Sciences/Mary Babb Randolph Cancer Center, West Virginia University, Morgantown, WV USA
| | - John J. Godleski
- Center for Nanotechnology and Nanotoxicology. Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, 665 Huntington Avenue, Room 1310, Boston, MA 02115 USA
| | - Philip Demokritou
- Center for Nanotechnology and Nanotoxicology. Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, 665 Huntington Avenue, Room 1310, Boston, MA 02115 USA
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Tsai T, Lo L, Liu S, Cheng W, Chou Y, Lin W, Shinya Y, Lin Y, Chang S, Hu Y, Chung F, Liao J, Chao T, Tuan T, Chen S. Ambient fine particulate matter (PM2.5) exposure is associated with idiopathic ventricular premature complexes burden: A cohort study with consecutive Holter recordings. J Cardiovasc Electrophysiol 2019; 30:487-492. [DOI: 10.1111/jce.13829] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 11/20/2018] [Accepted: 12/03/2018] [Indexed: 01/02/2023]
Affiliation(s)
- Tsung‐Ying Tsai
- Division of Cardiology, Department of MedicineTaipei Veterans General HospitalTaipei Taiwan
| | - Li‐Wei Lo
- Division of Cardiology, Department of MedicineTaipei Veterans General HospitalTaipei Taiwan
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang‐Ming UniversityTaipei Taiwan
| | - Shin‐Huei Liu
- Division of Cardiology, Department of MedicineTaipei Veterans General HospitalTaipei Taiwan
| | - Wen‐Han Cheng
- Division of Cardiology, Department of MedicineTaipei Veterans General HospitalTaipei Taiwan
| | - Yu‐Hui Chou
- Division of Cardiology, Department of MedicineTaipei Veterans General HospitalTaipei Taiwan
| | - Wei‐Lun Lin
- Division of Cardiology, Department of MedicineTaipei Veterans General HospitalTaipei Taiwan
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang‐Ming UniversityTaipei Taiwan
| | - Yamada Shinya
- Division of Cardiology, Department of MedicineTaipei Veterans General HospitalTaipei Taiwan
| | - Yenn‐Jiang Lin
- Division of Cardiology, Department of MedicineTaipei Veterans General HospitalTaipei Taiwan
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang‐Ming UniversityTaipei Taiwan
| | - Shih‐Lin Chang
- Division of Cardiology, Department of MedicineTaipei Veterans General HospitalTaipei Taiwan
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang‐Ming UniversityTaipei Taiwan
| | - Yu‐Feng Hu
- Division of Cardiology, Department of MedicineTaipei Veterans General HospitalTaipei Taiwan
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang‐Ming UniversityTaipei Taiwan
| | - Fa‐Po Chung
- Division of Cardiology, Department of MedicineTaipei Veterans General HospitalTaipei Taiwan
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang‐Ming UniversityTaipei Taiwan
| | - Jo‐Nan Liao
- Division of Cardiology, Department of MedicineTaipei Veterans General HospitalTaipei Taiwan
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang‐Ming UniversityTaipei Taiwan
| | - Tze‐Fan Chao
- Division of Cardiology, Department of MedicineTaipei Veterans General HospitalTaipei Taiwan
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang‐Ming UniversityTaipei Taiwan
| | - Ta‐Chuan Tuan
- Division of Cardiology, Department of MedicineTaipei Veterans General HospitalTaipei Taiwan
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang‐Ming UniversityTaipei Taiwan
| | - Shih‐Ann Chen
- Division of Cardiology, Department of MedicineTaipei Veterans General HospitalTaipei Taiwan
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang‐Ming UniversityTaipei Taiwan
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Folino F, Buja G, Zanotto G, Marras E, Allocca G, Vaccari D, Gasparini G, Bertaglia E, Zoppo F, Calzolari V, Suh RN, Ignatiuk B, Lanera C, Benassi A, Gregori D, Iliceto S. Association between air pollution and ventricular arrhythmias in high-risk patients (ARIA study): a multicentre longitudinal study. Lancet Planet Health 2017; 1:e58-e64. [PMID: 29851582 DOI: 10.1016/s2542-5196(17)30020-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 02/18/2017] [Accepted: 03/15/2017] [Indexed: 05/27/2023]
Abstract
BACKGROUND Although the effects of air pollution on mortality have been clearly shown in many epidemiological and observational studies, the pro-arrhythmic effects remain unknown. We aimed to assess the short-term effects of air pollution on ventricular arrhythmias in a population of high-risk patients with implantable cardioverter-defibrillators (ICDs) or cardiac resynchronisation therapy defibrillators (ICD-CRT). METHODS In this prospective multicentre study, we assessed 281 patients (median age 71 years) across nine centres in the Veneto region of Italy. Episodes of ventricular tachycardia and ventricular fibrillation that were recorded by the diagnostic device were considered in this analysis. Concentrations of particulate matter of less than 10 μm (PM10) and less than 2·5 μm (PM2·5) in aerodynamic diameter, carbon monoxide, nitrogen dioxide, sulphur dioxide, and ozone were obtained daily from monitoring stations, and the 24 h median value was considered. Each patient was associated with exposure data from the monitoring station that was closest to their residence. Patients were followed up for 1 year and then scheduled to have a closing visit, within 1 more year. This study is registered with ClinicalTrials.gov, number NCT01723761. FINDINGS Participants were enrolled from April 1, 2011, to Sept 30, 2012, and follow-ups (completed on April 5, 2014) ranged from 637 to 1177 days (median 652 days). The incidence of episodes of ventricular tachycardia and ventricular fibrillation correlated significantly with PM2·5 (p<0·0001) but not PM10. An analysis of ventricular fibrillation episodes alone showed a significant increase in risk of higher PM2·5 (p=0·002) and PM10 values (p=0·0057). None of the gaseous pollutants were significantly linked to the occurrence of ventricular tachycardia or ventricular fibrillation. In a subgroup analysis of patients with or without a previous myocardial infarction, only the first showed a significant association between particulate matter and episodes of ventricular tachycardia or ventricular fibrillation. INTERPRETATION Particulate matter has acute pro-arrhythmic effects in a population of high-risk patients, which increase on exposure to fine particles and in patients who have experienced a previous myocardial infarction. The time sequence of the arrhythmic events suggests there is an underlying neurally mediated mechanism. From a clinical point of view, the results of our study should encourage physicians to also consider environmental risk when addressing the prevention of arrhythmic events, particularly in patients with coronary heart disease, advising them to avoid exposure to high levels of fine particulate matter. FUNDING There was no funding source for this study.
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Affiliation(s)
- Franco Folino
- Department of Cardiac Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
| | - Gianfranco Buja
- Department of Cardiac Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Gabriele Zanotto
- Department of Cardiology, Mater Salutis Hospital, Legnago, Italy
| | - Elena Marras
- Department of Cardiology, S Maria dei Battuti Hospital, Conegliano, Italy
| | - Giuseppe Allocca
- Department of Cardiology, S Maria dei Battuti Hospital, Conegliano, Italy
| | - Diego Vaccari
- Department of Cardiology, Civic Hospital, Montebelluna, Italy
| | | | - Emanuele Bertaglia
- Department of Cardiac Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Franco Zoppo
- Department of Cardiology, Civic Hospital, Mirano, Italy
| | | | - Rene Nangah Suh
- Department of Cardiology, Civic Hospital, Portogruaro, Italy
| | | | - Corrado Lanera
- Department of Cardiac Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Alessandro Benassi
- Regional Agency for Environmental Prevention and Protection of the Veneto Region, Padua, Italy
| | - Dario Gregori
- Department of Cardiac Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Sabino Iliceto
- Department of Cardiac Thoracic and Vascular Sciences, University of Padua, Padua, Italy
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