Association of Air Pollution with Ventricular Arrhythmias and Physical Activity: A Natural Experiment from US Wildfires.
Academic Article
Overview
abstract
BACKGROUND: The association between particulate matter (PM) air pollution and ventricular arrhythmias is not well established. In patients with cardiac implantable electronic devices (CIED), publicly available day-level air pollution data provide a unique opportunity to study acute and subacute effects of particulate matter pollution. OBJECTIVE: To evaluate the association of air pollution with ventricular arrhythmias, physical activity, and CIED markers of heart failure. METHODS: We performed a retrospective cohort study using the CERTITUDE database of CIED patients. The primary predictors were Air Quality Index (AQI), PM<10μm in diameter (PM10), and PM<2.5μm in diameter (PM2.5). We cross-linked day-level air pollutant levels to patient zip codes. We determined the association of air pollution to CIED parameters using (1) a case-crossover analysis using a conditional logistic regression and (2) a time-varying exposure analysis using an Andersen-Gill model. RESULTS: The study cohort included 28349 patients (32% female, age 72.8±11.9), of whom 17448 (61.6%) had pacemakers and 9079 (32%) had defibrillators. AQI and PM2.5 were associated with significant changes in physical activity, heart rate, and thoracic impedance. When limiting to the 8687 patients living in Western US Fire States (AZ/CA/CO/NM/NV/OR/UT/WA), there was a strong association between PM2.5 and PVC burden, with an odds ratio of 7.72 (95% confidence interval: 7.48-7.96; p<0.0001) for PM2.5≥13.7. Multiple sensitivity analyses demonstrated the stability of our findings. CONCLUSION: In a large cohort of CIED patients, AQI and PM2.5 had significant associations with PVC burden, physical activity and heart rate. These data also demonstrate the feasibility of linking environmental data with patient sensor data to evaluate exposure-outcome relationships.
