Ambient air pollution and subclinical atrial and ventricular arrhythmias in cardiac implantable electronic devices (CIEDs) monitored patients: a prospective multicenter cohort study
J Kim, N Ahn, Y Lee, W Kim, M YoonAbstract
Background and aims
Atrial high-rate episodes (AHREs) are clinically significant as they serve as precursors to atrial fibrillation, a major risk factor for stroke. However, ventricular high-rate episodes (VHREs) also occur and can indicate patients experiencing either non-sustained ventricular tachycardia (NSVT) or sustained ventricular tachycardia. Recent studies have indicated that exposure to fine particulate matter (PM2.5) is associated with increased incidences of subclinical arrhythmias. Nonetheless, data on the association between PM2.5 exposure and subclinical arrhythmias, particularly among patients with cardiac implantable electronic devices (CIEDs), remain limited.
Materials and methods
We conducted a prospective, nationwide cross-sectional study utilizing data collected between August 1, 2021, and July 31, 2023, from 8 multicenter cohorts. Geocoding and Generalized estimating equations (GEE) were employed to examine associations between air pollutants (PM2.5, PM10, O3, NO2, SO2, and CO) and episodes of AHREs and VHREs. Air pollutant concentrations were obtained from high-resolution, high-quality spatiotemporal datasets provided by Air Korea’s daily pollution monitoring system.
Results
Of 217,102 eligible observations analyzed, subclinical arrhythmias were identified in 318 patients, with 2,155 atrial arrhythmia episodes and 695 ventricular arrhythmia episodes documented. Among evaluated pollutants, SO2 exposure exhibited a statistically significant positive association with the risk of overall arrhythmia (OR 2.723, 95% CI 1.016–7.296). In contrast, PM10 (OR 1.000, 95% CI 0.982–1.019), PM2.5 (OR 1.005, 95% CI 0.986–1.025), NO2 (OR 1.026, 95% CI 0.966–1.090), CO (OR 1.002, 95% CI 0.998–1.006), and O3 (OR 0.993, 95% CI 0.955–1.032) showed no significant associations with overall arrhythmia risk. For atrial arrhythmias, SO2 again demonstrated a significant association (OR 3.865, 95% CI 1.457–10.251), whereas PM10 (OR 0.990, 95% CI 0.971–1.010), PM2.5 (OR 1.004, 95% CI 0.984–1.025), NO2 (OR 1.045, 95% CI 0.977–1.117), CO (OR 1.003, 95% CI 0.999–1.007), and O3 (OR 0.980, 95% CI 0.937–1.026) were not significantly associated with AHRE risk. In contrast to the findings for atrial arrhythmias, none of the pollutants were significantly associated with the risk of ventricular arrhythmias. PM10 (OR 1.027, 95% CI 0.993–1.061), PM2.5 (OR 1.008, 95% CI 0.969–1.048), NO2 (OR 0.949, 95% CI 0.848–1.062), SO2 (OR 0.790, 95% CI 0.089–6.991), CO (OR 1.000, 95% CI 0.993–1.007), and O3 (OR 1.042, 95% CI 0.993–1.094) all showed no detectable pollutant-specific effect on VHRE risk in this cohort.
Conclusion
In this prospective multicenter cohort of CIED-monitored patients, short-term exposure to ambient air pollution—particularly sulfur dioxide, a representative component of combustion-related pollutant mixtures—was associated with a significantly increased risk of overall subclinical arrhythmias and atrial high-rate episodes.