• Xiaowei Xue, Jialu Hu, Dingcheng Xiang, Huichu Li, Yixuan Jiang, Weiyi Fang, Hongbing Yan, Jiyan Chen, Weimin Wang, Xi Su, Bo Yu, Yan Wang, Yawei Xu, Lefeng Wang, Chunjie Li, Yundai Chen, Dong Zhao, Haidong Kan, Junbo Ge, Yong Huo, and Renjie Chen.
• School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Lab of Health Technology Assessment (Xue, Jiang, Kan, R. Chen), Fudan University, Shanghai, China; Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine (Hu, Ge), Shanghai, China; Department of Cardiology (Xiang), General Hospital of Southern Theater Command of PLA, Guangzhou, China; Department of Environmental Health (H. Li), Harvard T.H. Chan School of Public Health, Boston, Mass.; Department of Cardiology (Fang), Huadong Hospital, Fudan University, Shanghai, China; Center for Coronary Artery Diseases (Yan), Chinese Academy of Medical Sciences in Shenzhen, Shenzhen, China; Center for Coronary Artery Diseases (Yan), Chinese Academy of Medical Sciences, Beijing, China; Department of Cardiology (J. Chen), Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China; Department of Cardiology (W. Wang), Peking University People's Hospital, Beijing, China; Department of Cardiology (Su), Wuhan ASIA General Hospital, Wuhan, China; Department of Cardiology (Yu), The 2nd Affiliated Hospital, Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China; Department of Cardiology (Y. Wang), Xiamen Cardiovascular Hospital Xiamen University, Xiamen, China; Department of Cardiology (Xu), Shanghai Tenth People's Hospital, Shanghai, China; Heart Center and Beijing Key Laboratory of Hypertension (L. Wang), Beijing Chaoyang Hospital, Capital Medical University, Beijing, China; Department of Emergency (C. Li), Tianjin Chest Hospital, Tianjin, China; Senior Department of Cardiology (Y. Chen), the Sixth Medical Center of PLA General Hospital, Beijing, China; Department of Epidemiology (Zhao), Beijing An Zhen Hospital, Capital Medical University; Beijing Institute of Heart, Lung and Blood Vessel Diseases (Zhao), Beijing, China; Department of Cardiology (Huo), Peking University First Hospital, Beijing, China.
• CMAJ. 2023 May 1; 195 (17): E601E611E601-E611.

BackgroundFew studies have explored the relationship between air pollution and arrhythmia onset at the hourly level. We aimed to examine the association of exposure to air pollution with the onset of acute symptomatic arrhythmia at an hourly level.MethodsWe conducted a nationwide, time-stratified, case-crossover study in China between 2015 and 2021. We obtained hourly information on the onset of symptomatic arrhythmia (including atrial fibrillation, atrial flutter, atrial and ventricular premature beats and supraventricular tachycardia) from the Chinese Cardiovascular Association Database - Chest Pain Center (including 2025 certified hospitals in 322 cities). We obtained data on hourly concentrations of 6 air pollutants from the nearest monitors, including fine particles (PM2.5), coarse particles (PM2.5-10), nitrogen dioxide (NO2), sulfur dioxide (SO2), carbon monoxide (CO) and ozone. For each patient, we matched the case period to 3 or 4 control periods during the same hour, day of week, month and year. We used conditional logistic regression models to analyze the data.ResultsWe included a total of 190 115 patients with acute onset of symptomatic arrhythmia. Air pollution was associated with increased risk of onset of symptomatic arrhythmia within the first few hours of exposure; this risk attenuated substantially after 24 hours. An interquartile range increase in PM2.5, NO2, SO2 and CO in the first 24 hours after exposure (i.e., lag period 0-24 h) was associated with significantly higher odds of atrial fibrillation (1.7%-3.4%), atrial flutter (8.1%-11.4%) and supraventricular tachycardia (3.4%-8.9%). Exposure to PM2.5-10 was associated with significantly higher odds of atrial flutter (8.7%) and supraventricular tachycardia (5.4%), and exposure to ozone was associated with higher odds of supraventricular tachycardia (3.4%). The exposure-response relationships were approximately linear, without discernible concentration thresholds.InterpretationExposure to air pollution was associated with the onset of symptomatic arrhythmia shortly after exposure. This finding highlights the importance of further reducing air pollution and taking prompt protective measures for susceptible populations during periods of elevated levels of air pollutants.© 2023 CMA Impact Inc. or its licensors.

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