title: Association of air pollution with increased incidence of ventricular tachyarrhythmias recorded by implanted cardioverter defibrillators.
abstract: Epidemiologic studies have demonstrated a consistent link between sudden cardiac deaths and particulate air pollution. We used implanted cardioverter defibrillator (ICD) records of ventricular tachyarrhythmias to assess the role of air pollution as a trigger of these potentially life-threatening events. The study cohort consisted of 203 cardiac patients with ICD devices in the Boston metropolitan area who were followed for an average of 3.1 years between 1995 and 2002. Fine particle mass and gaseous air pollution plus temperature and relative humidity were measured on almost all days, and black carbon, sulfate, and particle number on a subset of days. Date, time, and intracardiac electrograms of ICD-detected arrhythmias were downloaded at the patients' regular follow-up visits (about every 3 months). Ventricular tachyarrhythmias were identified by electrophysiologist review. Risk of ventricular arrhythmias associated with air pollution was estimated with logistic regression, adjusting for season, temperature, relative humidity, day of the week, patient, and a recent prior arrhythmia. We found increased risks of ventricular arrhythmias associated with 2-day mean exposure for all air pollutants considered, although these associations were not statistically significant. We found statistically significant associations between air pollution and ventricular arrhythmias for episodes within 3 days of a previous arrhythmia. The associations of ventricular tachyarrhythmias with fine particle mass, carbon monoxide, nitrogen dioxide, and black carbon suggest a link with motor vehicle pollutants. The associations with sulfate suggest a link with stationary fossil fuel combustion sources.
authors.affiliation: Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts 02215, USA. ddockery@hsph.harvard.edu
authors.forename: Douglas W
authors.initials: DW
authors.lastname: Dockery
authors.forename: Heike
authors.initials: H
authors.lastname: Luttmann-Gibson
authors.forename: David Q
authors.initials: DQ
authors.lastname: Rich
authors.forename: Mark S
authors.initials: MS
authors.lastname: Link
authors.forename: Murray A
authors.initials: MA
authors.lastname: Mittleman
authors.forename: Diane R
authors.initials: DR
authors.lastname: Gold
authors.forename: Petros
authors.initials: P
authors.lastname: Koutrakis
authors.forename: Joel D
authors.initials: JD
authors.lastname: Schwartz
authors.forename: Richard L
authors.initials: RL
authors.lastname: Verrier
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000393:Air Pollutants / Q000009:adverse effects* / Q000032:analysis; D000397:Air Pollution / Q000009:adverse effects*; D002244:Carbon / Q000009:adverse effects / Q000032:analysis; D002248:Carbon Monoxide / Q000009:adverse effects / Q000032:analysis; D017147:Defibrillators, Implantable; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009585:Nitrogen Dioxide / Q000009:adverse effects / Q000032:analysis; D010316:Particle Size; D013431:Sulfates / Q000009:adverse effects / Q000032:analysis; D013458:Sulfur Dioxide / Q000009:adverse effects / Q000032:analysis; D017180:Tachycardia, Ventricular / Q000453:epidemiology* / Q000628:therapy
chemical_list: D000393:Air Pollutants; D013431:Sulfates; D013458:Sulfur Dioxide; D002244:Carbon; D002248:Carbon Monoxide; D009585:Nitrogen Dioxide