Air Quality, Atmosphere & Health

, Volume 8, Issue 4, pp 413–420 | Cite as

Can air pollution trigger an onset of atrial fibrillation: a population-based study

  • Maayan Yitshak Sade
  • Alina Vodonos
  • Victor Novack
  • Michael Friger
  • Guy Amit
  • Itzhak Katra
  • Joel Schwartz
  • Lena Novack


Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia and a major risk factor for ischemic stroke. Previous data showed an effect of nitric dioxide, carbon monoxide, ozone, and particulate matter (PM) smaller than 2.5 μm in diameter on atrial fibrillation development. This study aims to evaluate the effect of air pollution on the new AF onset requiring hospitalization. A case-crossover analysis was performed on a population of patients hospitalized in a large tertiary teaching hospital between 2006 and 2010 with first life occurrence of atrial fibrillation; 1458 patients were admitted to the hospital with new-onset AF. AF onset was associated with an interquartile range elevation of carbon monoxide concentrations during the winter season (odds ratio 1.15, p = 0.040) and sulfur dioxide concentrations during the fall season (odds ratio 1.21, p = 0.028). An interquartile range elevation in nitric dioxide concentration was associated with AF onset only among patients younger than 65 years of age (odds ratio 1.08, p = 0.025). Patients with diabetes mellitus or chronic obstructive pulmonary disorder had higher susceptibility for carbon monoxide-associated AF development. Short-term exposure to carbon monoxide, nitric dioxide, and sulfur dioxide was associated with AF onset, suggesting that these pollutants, originating primarily from traffic, might trigger new AF. This knowledge is essential for understanding a pathophysiology of the disease onset and for the development of recommendations for susceptible patients.


Atrial fibrillation Traffic Air pollution Carbon monoxide 


  1. Alboni P, Botto GL, Boriani G, Russo G, Pacchioni F, Iori M, Pasanisi G, Mancini M, Mariconti B, Capucci A (2010) Intravenous administration of flecainide or propafenone in patients with recent-onset atrial fibrillation does not predict adverse effects during ‘pill-in-the-pocket’ treatment. Heart 96:546–549CrossRefGoogle Scholar
  2. Alpert P, Osetinsky I, Ziv B, Shafir H (2004) A new seasons definition based on classified daily synoptic systems: an example for the Eastern Mediterranean. Int J Climatol 24:1013–1021CrossRefGoogle Scholar
  3. Asaf D, Pedersen D, Peleg M, Matveev V, Luria M (2008) Evaluation of background levels of air pollutants over Israel. Atmos Environ 42:8453–8463CrossRefGoogle Scholar
  4. Aviles RJ, Martin DO, Apperson-Hansen C, Houghtaling PL, Rautaharju P, Kronmal RA, Tracy RP, Van Wagoner DR, Psaty BM, Lauer MS, Chung MK (2003) Inflammation as a risk factor for atrial fibrillation. Circulation 108:3006–3010CrossRefGoogle Scholar
  5. Barnett AG, Williams GM, Schwartz J, Best TL, Neller AH, Petroeschevsky AL, Simpson RW (2006) The effects of air pollution on hospitalizations for cardiovascular disease in elderly people in Australian and New Zealand cities. Environ Health Perspect 114:1018–1023CrossRefGoogle Scholar
  6. Bateson TF, Schwartz J (2004) Who is sensitive to the effects of particulate air pollution on mortality? A case-crossover analysis of effect modifiers. Epidemiology 15:143–149CrossRefGoogle Scholar
  7. Benjamin EJ, Levy D, D'Agostino RB, Belanger AJ, Wolf PA (1995) Impact of atrial fibrillation on the risk of death: the Framingham Study. J Am Coll Cardiol 0:230AGoogle Scholar
  8. Berger A, Zareba W, Schneider A, Rueckerl R, Ibald-Mulli A, Cyrys J, Wichmann HE, Peters A (2006) Runs of ventricular and supraventricular tachycardia triggered by air pollution in patients with coronary heart disease. J Occup Environ Med 48:1149–1158CrossRefGoogle Scholar
  9. Bunch TJ, Horne BD, Asirvatham SJ, Day JD, Crandall BG, Weiss JP, Osborn JS, Anderson JL, Muhlestein JB, Lappe DL, Pope CA (2011) Atrial fibrillation hospitalization is not increased with short-term elevations in exposure to fine particulate air pollution. Pace-Pacing Clin Electrophysiol 34:1475–1479CrossRefGoogle Scholar
  10. Chen H, Goldberg MS, Burnett RT, Jerrett M, Wheeler AJ, Villeneuve PJ (2013) Long-term exposure to traffic-related air pollution and cardiovascular mortality. Epidemiology 24:35–43CrossRefGoogle Scholar
  11. Dockery DW, Luttmann-Gibson H, Rich DQ, Link MS, Schwartz JD, Gold DR, Mittleman MA (2005) Particulate air pollution and nonfatal cardiac events. Part II. Association of air pollution with confirmed arrhythmias recorded by implanted defibrillators. In: Book 124. Health Effect Institute, Research reportGoogle Scholar
  12. Ganor E, Stupp A, Alpert P (2009) A method to determine the effect of mineral dust aerosols on air quality. Atmos Environ 43:5463–5468CrossRefGoogle Scholar
  13. Ghelfi E, Ramos-Rhoden C, Wellenius GA, Lawrence J, Gonzalez-Flecha B (2008) Cardiac oxidative stress and electrophysiological changes in rats exposed to concentrated ambient particles are mediated by TRP-dependent pulmonary reflexes. Toxicol Sci 102:328–336CrossRefGoogle Scholar
  14. Go AS, Hylek EM, Phillips KA, Chang YC, Henault LE, Selby JV, Singer DE (2001) Prevalence of diagnosed atrial fibrillation in adults—national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) study. JAMA J Am Med Assoc 285:2370–2375CrossRefGoogle Scholar
  15. Goldreich Y (2003) The climate of Israel: observation, research, and application. Kluwer Academic, New YorkCrossRefGoogle Scholar
  16. Healey JS, Connolly SJ, Hohnloser SH (2012) Subclinical atrial fibrillation and the risk of stroke REPLY. N Engl J Med 366:1352–1353CrossRefGoogle Scholar
  17. Janes H, Sheppard L, Lumley T (2005) Overlap bias in the case-crossover design, with application to air pollution exposures. Stat Med 24:285–300CrossRefGoogle Scholar
  18. Kordysh E, Karakis I, Belmaker I, Vardi H, Bolotin A, Sarov B (2005) Respiratory morbidity in hospitalized Bedouins residing near an industrial park. Arch Environ Occup Health 60:147–155CrossRefGoogle Scholar
  19. Krasnov H, Katra I, Koutrakis P, Friger MD (2014) Contribution of dust storms to PM10 levels in an urban arid environment. J Air Waste Manage Assoc 64:89–94CrossRefGoogle Scholar
  20. Lepeule J, Laden F, Dockery D, Schwartz J (2012) Chronic exposure to fine particles and mortality: an extended follow-up of the Harvard Six Cities Study from 1974 to 2009. Environ Health Perspect 120:965–970CrossRefGoogle Scholar
  21. Liao D, Shaffer ML, He F, Rodriguez-Colon S, Wu R, Whitsel EA, Bixler EO, Cascio WE (2011) Fine particulate air pollution is associated with higher vulnerability to atrial fibrillation: the Apacr Study. J Toxicol Environ Health Part A Curr Issues 74:693–705CrossRefGoogle Scholar
  22. Link MS, Luttmann-Gibson H, Schwartz J, Mittleman MA, Wessler B, Gold DR, Dockery DW, Laden F (2013) Acute exposure to air pollution triggers atrial fibrillation. J Am Coll Cardiol 62:816–825CrossRefGoogle Scholar
  23. Madrigano J, Kloog I, Goldberg R, Coull BA, Mittleman MA, Schwartz J (2013) Long-term exposure to PM2.5 and incidence of acute myocardial infarction. Environ Health Perspect 121:192–196Google Scholar
  24. Metzger KB, Klein M, Flanders WD, Peel JL, Mulholland JA, Langberg JJ, Tolbertf PE (2007) Ambient air pollution and cardiac arrhythmias in patients with implantable defibrillators. Epidemiology 18:585–592CrossRefGoogle Scholar
  25. Moeller DW (2005) Environmental health. Harvard College, USAGoogle Scholar
  26. Peters A, Liu E, Verrier RL, Schwartz J, Gold DR, Mittleman M, Baliff J, Oh JA, Allen G, Monahan K, Dockery DW (2000) Air pollution and incidence of cardiac arrhythmia. Epidemiology 11:11–17CrossRefGoogle Scholar
  27. Pope CA, Burnett RT, Thurston GD, Thun MJ, Calle EE, Krewski D, Godleski JJ (2004) Cardiovascular mortality and long-term exposure to particulate air pollution—epidemiological evidence of general pathophysiological pathways of disease. Circulation 109:71–77CrossRefGoogle Scholar
  28. Powell H, Lim LLY, Heller RF (2001) Accuracy of administrative data to assess comorbidity in patients with heart disease: an Australian perspective. J Clin Epidemiol 54:687–693CrossRefGoogle Scholar
  29. Rich KE, Petkau J, Vedal S, Brauer M (2004) A case-crossover analysis of particulate air pollution and cardiac arrhythmia in patients with implantable cardioverter defibrillators. Inhal Toxicol 16:363–372CrossRefGoogle Scholar
  30. Rich DQ, Schwartz J, Mittleman MA, Link M, Luttmann-Gibson H, Catalano PJ, Speizer FE, Dockery DW (2005) Association of short-term ambient air pollution concentrations and ventricular arrhythmias. Am J Epidemiol 161:1123–1132CrossRefGoogle Scholar
  31. Rich DQ, Mittleman MA, Link MS, Schwartz J, Luttmann-Gibson H, Catalano PJ, Speizer FE, Gold DR, Dockery DW (2006) Increased risk of paroxysmal atrial fibrillation episodes associated with acute increases in ambient air pollution. Environ Health Perspect 114:120–123CrossRefGoogle Scholar
  32. Roy D, Talajic M, Dubuc M, Thibault B, Guerra P, Macle L, Khairy P (2009) Atrial fibrillation and congestive heart failure. Curr Opin Cardiol 24:29–34CrossRefGoogle Scholar
  33. Santos UD, Braga ALF, Giorgi DMA, Pereira LAA, Grupi CJ, Lin CA, Bussacos MA, Zanetta DMT, Saldiva PHD, Terra M (2005) Effects of air pollution on blood pressure and heart rate variability: a panel study of vehicular traffic controllers in the city of Sao Paulo, Brazil. Eur Heart J 26:193–200CrossRefGoogle Scholar
  34. Schneider A, Schuh A, Maetzel FK, Ruckerl R, Breitner S, Peters A (2008) Weather-induced ischemia and arrhythmia in patients undergoing cardiac rehabilitation: another difference between men and women. Int J Biometeorol 52:535–547CrossRefGoogle Scholar
  35. Smith JG, Platonov PG, Hedblad B, Engstrom G, Melander O (2010) Atrial fibrillation in the Malmo diet and cancer study: a study of occurrence, risk factors and diagnostic validity. Eur J Epidemiol 25:95–102CrossRefGoogle Scholar
  36. Tunnicliffe WS, Hilton MF, Ayres JG (1999) The effect of sulphur dioxide (SO2) exposure on indices of heart rate variability (HRV) in normal and asthmatic adults. Am J Respir Crit Care Med 159:A318–A318Google Scholar
  37. Vedal S, Rich K, Brauer M, White R, Petkau J (2004) Air pollution and cardiac arrhythmias in patients with implantable cardioverter defibrillators. Inhal Toxicol 16:353–362CrossRefGoogle Scholar
  38. Vodonos A, Friger M, Katra I, Avnon L, Krasnov H, Koutrakis P, Schwartz J, Lior O, Novack V (2014) The impact of desert dust exposures on hospitalizations due to exacerbation of chronic obstructive pulmonary disease. Air Qual Atmos Health 1–7 doi: 10.1007/s11869-014-0253-z
  39. Whitsel EA, Avery CL (2010) The environmental epidemiology of atrial arrhythmogenesis. J Epidemiol Community Health 64:587–590CrossRefGoogle Scholar
  40. Yitshak Sade M, Novack V, Katra I, Gorodischer R, Tal A, Novack L (2014) Non-anthropogenic dust exposure and asthma medications purchase in children. Eur Respir J (in press)Google Scholar
  41. Zanobetti A, Schwartz J (2001) Are diabetics more susceptible to the health effects of airborne particles? Am J Respir Crit Care Med 164:831–833CrossRefGoogle Scholar
  42. Zanobetti A, Schwartz J (2005) The effect of particulate air pollution on emergency admissions for myocardial infarction: a multicity case-crossover analysis. Environ Health Perspect 113:978–982CrossRefGoogle Scholar
  43. Zanobetti A, Schwartz J, Gold D (2000) Are there sensitive subgroups for the effects of airborne particles? Environ Health Perspect 108:841–845CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2014

Authors and Affiliations

  • Maayan Yitshak Sade
    • 1
    • 2
  • Alina Vodonos
    • 1
    • 2
  • Victor Novack
    • 2
  • Michael Friger
    • 1
  • Guy Amit
    • 3
  • Itzhak Katra
    • 4
  • Joel Schwartz
    • 5
  • Lena Novack
    • 1
  1. 1.Faculty of Health SciencesBen-Gurion University of the NegevBeer ShevaIsrael
  2. 2.Clinical Research CenterSoroka University Medical CenterBeer ShevaIsrael
  3. 3.Department of CardiologySoroka University Medical CenterBeer ShevaIsrael
  4. 4.Department of Geography and Environmental Development, Faculty of Humanities and Social SciencesBen-Gurion University of the NegevBeer ShevaIsrael
  5. 5.Environmental Epidemiology Program, Department of Environmental HealthHarvard School of Public HealthBostonUSA

Personalised recommendations