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European Heart Journal Advance Access originally published online on November 12, 2008
European Heart Journal 2008 29(23):2894-2901; doi:10.1093/eurheartj/ehn463
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Rapid effects of air pollution on ventricular arrhythmias

Petter L.S. Ljungman1,2, Niklas Berglind2, Christina Holmgren3, Fredrik Gadler4, Nils Edvardsson3, Göran Pershagen2,5, Mårten Rosenqvist1, Bengt Sjögren2 and Tom Bellander2,5,*

1 Department of Cardiology, Karolinska Institutet, Stockholm South General Hospital, Stockholm, Sweden
2 Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
3 Division of Cardiology, Sahlgrenska University Hospital, Göteborg, Sweden
4 Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
5 Department of Occupational and Environmental Health, Stockholm County Council, Norrbacka, Stockholm SE 171 76, Sweden

Received 21 February 2008; revised 24 September 2008; accepted 29 September 2008; online publish-ahead-of-print 12 November 2008.

* Corresponding author. Tel: +46 8 737 36 70, Fax: +46 8 737 37 70, Email: tom.bellander{at}sll.se

Aims: Air pollution has been associated with ventricular arrhythmias in patients with implantable cardioverter defibrillators (ICDs) for exposure periods of 24–48 h. Only two studies have investigated exposure periods <24 h. We aimed to explore such effects during the 2 and 24 preceding hours as well as in relation to distance from the place of the event to the air pollution monitor.

Methods and results: We used a case-crossover design to investigate the effects of particulate matter <10 µm in diameter (PM10) and nitrogen dioxide (NO2) in 211 patients with ICD devices in Gothenburg and Stockholm, Sweden. Events interpreted as ventricular arrhythmias were downloaded from the ICDs, and air pollution data were collected from urban background monitors. We found an association between 2 h moving averages of PM10 and ventricular arrhythmia [odds ratio (OR) 1.31, 95% confidence interval (CI) 1.00–1.72], whereas the OR for 24 h moving averages was 1.24 (95% CI 0.87–1.76). Corresponding ORs for events occurring closest to the air pollution monitor were 1.76 (95% CI 1.18–2.61) and 1.74 (95% CI 1.07–2.84), respectively. Events occurring in Gothenburg showed stronger associations than in Stockholm.

Conclusion: Moderate increases in air pollution appear to be associated with ventricular arrhythmias in ICD patients already after 2 h, although future studies including larger numbers of events are required to confirm these findings. Representative geographical exposure classification seems important in studies of these effects.

Key Words: Implantable cardioverter defibrillator • Air pollution • Tachycardia • Ventricular fibrillation • Heart arrest • Particulate matter


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