nitrogen-dioxide and Arrhythmias--Cardiac

Exposure to single pollutants e.g. particulate matter (PM) is associated with adverse health effects, but it does not represent a real world scenario that usually involves multiple pollutants.. Determine if simultaneous exposure to PM and NO₂ results in synergistic interactions.. Healthy young volunteers were exposed to clean air, nitrogen dioxide (NO₂, 0.5 ppm), concentrated fine particles from Chapel Hill air (PM(2.5)CAPs, 89.5 ± 10.7 µg/m³), or NO₂+PM(2.5)CAPs for 2 h. Each subject performed intermittent exercise during the exposure. Parameters of heart rate variability (HRV), changes in repolarization, peripheral blood endpoints and lung function were measured before and 1 and 18 h after exposure. Bronchoalveolar lavage (BAL) was performed 18 h after exposure.. NO₂ exposure alone increased cholesterol and HDL 18 h after exposure, decreased high frequency component of HRV one and 18 h after exposure, decreased QT variability index 1 h after exposure, and increased LDH in BAL fluid. The only significant change with PM(2.5)CAPs was an increase in HDL 1 h after exposure, likely due to the low concentrations of PM(2.5)CAPs in the exposure chamber. Exposure to both NO₂ and PM(2.5)CAPs increased BAL α1-antitrypsin, mean t wave amplitude, the low frequency components of HRV and the LF/HF ratio. These changes were not observed following exposure to NO₂ or PM(2.5)CAPs alone, suggesting possible interactions between the two pollutants.. NO₂ exposure may produce and enhance acute cardiovascular effects of PM(2.5)CAPs. Assessment of health effects by ambient PM should consider its interactions with gaseous copollutants.

Topics: Adult; Air Pollutants; alpha 1-Antitrypsin; Arrhythmias, Cardiac; Atmosphere Exposure Chambers; Bronchoalveolar Lavage Fluid; Cardiovascular Agents; Cardiovascular System; Cholesterol; Drug Synergism; Female; Heart Rate; Humans; Hypercholesterolemia; Lactate Dehydrogenases; Male; Nitrogen Dioxide; North Carolina; Particulate Matter; Young Adult

In this study, we investigated the correlation of air temperature, pressure and concentration\ of air pollutants with the rate of admissions for cardiac arrhythmias at two clinical centers\ in the area with a humid continental climate. This retrospective study included 3749 patients with\ arrhythmias admitted to emergency department (ED). They were classified into four groups: supraventricular\ tachycardia (SVT), ventricular tachycardia (VT), atrial fibrillation/undulation (Afib/Aund),\ and palpitations (with no ECG changes, or with sinus tachycardia and extrasystoles). The\ number of patients, values of meteorological parameters (average daily values of air temperature,\ pressure and relative humidity) and concentrations of air pollutants (particles of dimensions ~10\ micrometers or less (PM(10)), ozone (O(3)) and nitrogen dioxide (NO(2))) were collected during a two-year\ period ( July 2008-June 2010). There were 1650 (44.0%), 1525 (40.7%), 451 (12.0%) and 123 (3.3%)\ patients with palpitations, Afib/Aund, SVT and VT, respectively. Spearman’s correlation yielded\ positive correlation between the occurrence of arrhythmias and air humidity on the day (r=0.07), and\ 1 (r=0.08), 2 (r=0.09) and 3 days before (r=0.09), and NO(2) particles on the day (r=0.08) of ED admission;\ palpitations and air humidity on the day (r=0.11), and 1 (r=0.09), 2 (r=0.07) and 3 days before\ (r=0.10), and PM(10) (r=0.11) and NO(2) (r=0.08) particles on the day of ED admission; and Afi b/Aund\ and air humidity 2 days before (r=0.08) ED admission (p<0.05 all). In conclusion, there was a very\ weak positive correlation of the occurrence of cardiac arrhythmias with air humidity and concentration\ of air pollutants in the region with a humid continental climate.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Air Pollutants; Air Pollution; Air Pressure; Arrhythmias, Cardiac; Atrial Fibrillation; Climate; Croatia; Emergency Service, Hospital; Environmental Exposure; Female; Hospitalization; Humans; Humidity; Male; Middle Aged; Nitrogen Dioxide; Ozone; Particulate Matter; Retrospective Studies; Tachycardia, Supraventricular; Tachycardia, Ventricular; Temperature; Young Adult

Although the effects of air pollution on mortality have been clearly shown in many epidemiological and observational studies, the pro-arrhythmic effects remain unknown. We aimed to assess the short-term effects of air pollution on ventricular arrhythmias in a population of high-risk patients with implantable cardioverter-defibrillators (ICDs) or cardiac resynchronisation therapy defibrillators (ICD-CRT).. In this prospective multicentre study, we assessed 281 patients (median age 71 years) across nine centres in the Veneto region of Italy. Episodes of ventricular tachycardia and ventricular fibrillation that were recorded by the diagnostic device were considered in this analysis. Concentrations of particulate matter of less than 10 μm (PM. Participants were enrolled from April 1, 2011, to Sept 30, 2012, and follow-ups (completed on April 5, 2014) ranged from 637 to 1177 days (median 652 days). The incidence of episodes of ventricular tachycardia and ventricular fibrillation correlated significantly with PM. Particulate matter has acute pro-arrhythmic effects in a population of high-risk patients, which increase on exposure to fine particles and in patients who have experienced a previous myocardial infarction. The time sequence of the arrhythmic events suggests there is an underlying neurally mediated mechanism. From a clinical point of view, the results of our study should encourage physicians to also consider environmental risk when addressing the prevention of arrhythmic events, particularly in patients with coronary heart disease, advising them to avoid exposure to high levels of fine particulate matter.. There was no funding source for this study.

Topics: Aged; Air Pollutants; Air Pollution; Arrhythmias, Cardiac; Carbon Monoxide; Defibrillators, Implantable; Environmental Monitoring; Female; Humans; Male; Middle Aged; Myocardial Infarction; Nitrogen Dioxide; Ozone; Particulate Matter; Risk Factors; Sulfur Dioxide

Epidemiological studies suggest that increased ambient NO

Topics: Air Pollutants; Arrhythmias, Cardiac; Dose-Response Relationship, Drug; Environmental Monitoring; Hospitalization; Humans; Incidence; Inhalation Exposure; Linear Models; Nitrogen Dioxide; Poisson Distribution; Risk Assessment; Risk Factors; Seasons; Spain; Time Factors

Within urban air sheds, specific ambient air pollutants typically peak at predictable times throughout the day. For example, in environments dominated by mobile sources, peak nitrogen dioxide (NO2) levels coincide with morning and afternoon rush hours, while peak levels of ozone (O3), occur in the afternoon.. Given that exposure to a single pollutant might sensitize the cardiopulmonary system to the effects of a subsequent exposure to a second pollutant, we hypothesized that a morning exposure to NO2 will exaggerate the cardiovascular effects of an afternoon O3 exposure in rats.. Rats were divided into four groups that were each exposed for 3 h in the morning (m) and 3 h in the afternoon (a) on the same day: (1) m-Air/a-Air, (2) m-Air/a-O3 (0.3 ppm), (3) m-NO2 (0.5 ppm)/a-Air and (4) m-NO2/a-O3. Implanted telemetry devices recorded blood pressure and electrocardiographic data. Sensitivity to the arrhythmogenic agent aconitine was measured in a separate cohort.. Only m-NO2/a-O3-exposed rats had significant changes in electrophysiological, mechanical and autonomic parameters. These included decreased heart rate and increased PR and QTc intervals and increased heart rate variability, suggesting increased parasympathetic tone. In addition, only m-NO2/a-O3 exposure decreased systolic and diastolic blood pressures and increased pulse pressure and QA interval, suggesting decreased cardiac contractility.. The findings indicate that initial exposure to NO2 sensitized rats to the cardiovascular effects of O3 and may provide insight into the epidemiological data linking adverse cardiovascular outcomes with exposures to low concentrations of O3.

Topics: Aconitine; Administration, Inhalation; Air Pollutants; Animals; Arrhythmias, Cardiac; Blood Pressure; Electrocardiography; Heart Rate; Hypertension; Male; Nitrogen Dioxide; Ozone; Rats; Rats, Inbred SHR

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.. We used a case-crossover design to investigate the effects of particulate matter <10 microm 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.. 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.

Topics: Adult; Aged; Aged, 80 and over; Air Pollution; Arrhythmias, Cardiac; Cross-Over Studies; Death, Sudden, Cardiac; Defibrillators, Implantable; Environmental Exposure; Environmental Monitoring; Female; Heart Arrest; Humans; Male; Middle Aged; Nitrogen Dioxide; Odds Ratio; Oxidants, Photochemical; Particulate Matter; Sweden; Time Factors

It has previously been reported that the risk of ventricular arrhythmias is positively associated with ambient air pollution among patients with implantable cardioverter defibrillators (ICD) in Boston.. To assess the association of community exposures to air pollution with ventricular arrhythmias in a cohort of ICD patients in metropolitan St Louis, Missouri.. ICD detected episodes reported during clinical follow up were abstracted and reviewed by an electrophysiologist to identify ventricular arrhythmias. A total of 139 ventricular arrhythmias were identified among 56 patients. A case-crossover design was used with control periods matched on weekday and hour of the day within the same calendar month. Conditional logistic regression models were adjusted for temperature, barometric pressure, and relative humidity in the 24 hours preceding the event.. There was a significant (24%, 95% CI 7% to 44%) increase in risk of ventricular arrhythmias associated with each 5 ppb increase in mean sulphur dioxide and non-significantly increased risk (22%, 95% CI -6% to 60%; and 18%, 95% CI -7% to 50%) associated with increases in nitrogen dioxide (6 ppb) and elemental carbon (0.5 microg/m3), respectively in the 24 hours before the arrhythmia.. These results provide evidence of an association between ventricular arrhythmias and ambient air pollutants in St Louis. This is consistent with previous results from Boston, although the pollutants responsible for the increased risk are different.

Topics: Adult; Aged; Aged, 80 and over; Air Pollutants; Air Pollution; Arrhythmias, Cardiac; Cohort Studies; Cross-Over Studies; Defibrillators, Implantable; Female; Humans; Male; Middle Aged; Missouri; Nitrogen Dioxide; Particle Size; Sulfur Dioxide

Ambient particulate air pollution has been associated with increased risk of cardiovascular morbidity and mortality. Pathways by which particles may act involve autonomic nervous system dysfunction or inflammation, which can affect cardiac rate and rhythm. The importance of these pathways may vary by particle component or source. In an eastern US location with significant regional pollution, the authors examined the association of air pollution and odds of cardiac arrhythmia in older adults.. Thirty two non-smoking older adults were evaluated on a weekly basis for 24 weeks during the summer and autumn of 2000 with a standardised 30 minute protocol that included continuous electrocardiogram measurements. A central ambient monitoring station provided daily concentrations of fine particles (PM(2.5), sulfate, elemental carbon) and gases. Sulfate was used as a marker of regional pollution. The authors used logistic mixed effects regression to examine the odds of having any supraventricular ectopy (SVE) or ventricular ectopy (VE) in association with increases in air pollution for moving average pollutant concentrations up to 10 days before the health assessment.. Participant specific mean counts of arrhythmia over the protocol varied between 0.1-363 for SVE and 0-350 for VE. The authors observed odds ratios for having SVE over the length of the protocol of 1.42 (95% CI 0.99 to 2.04), 1.70 (95% CI 1.12 to 2.57), and 1.78 (95% CI 0.95 to 3.35) for 10.0 microg/m3, 4.2 microg/m3, and 14.9 ppb increases in five day moving average PM2.5, sulfate, and ozone concentrations respectively. The other pollutants, including elemental carbon, showed no effect on arrhythmia. Participants reporting cardiovascular conditions (for example, previous myocardial infarction or hypertension) were the most susceptible to pollution induced SVE. The authors found no association of pollution with VE.. Increased levels of ambient sulfate and ozone may increase the risk of supraventricular arrhythmia in the elderly.

Topics: Aged; Aged, 80 and over; Air Pollutants; Arrhythmias, Cardiac; Carbon; Electrocardiography; Female; Humans; Male; Middle Aged; Nitrogen Dioxide; Ozone; Sulfur Dioxide; Ventricular Dysfunction

Particulate air pollution has been associated with increased cardiovascular deaths and hospital admissions. To help understand the mechanisms, the types of particles most involved, and the types of persons most susceptible, the association between exposure to summertime air pollution and heart rate variability (HRV) was examined in a panel study of 28 elderly subjects.. Subjects were seen once a week for up to 12 weeks and HRV (SDNN, r-MSSD, PNN50, low frequency/high frequency ratio (LFHFR)) was measured for approximately 30 minutes at each session using a defined protocol. Temperature, day of the week, and hour of the day were controlled, and dummy variables for each subject were controlled for subject specific risk factors.. PM2.5 was associated with r-MSSD (-10.1% change for an interquartile range (IQR) increase in exposure (95% CI -2.8 to -16.9)) and PNN50, but stronger associations were seen with black carbon, an indicator of traffic particles, which was also associated with SDNN (-4.6% per IQR (95% CI -2.0 to -7.2)) and LFHFR. Secondary particles were more weakly associated with r-MSSD, as was ozone. No associations were seen with SO2 or NO2. CO had similar patterns of association to black carbon, which disappeared after controlling for black carbon. Black carbon had a substantially higher effect on SDNN in subjects who had had a previous myocardial infarction (-12.7%, 95% CI -5.7 to -19.25).. Particles, especially from traffic, are associated with disturbances of autonomic control of the heart.

Topics: Aged; Aged, 80 and over; Arrhythmias, Cardiac; Carbon; Carbon Monoxide; Electrocardiography, Ambulatory; Female; Humans; Male; Middle Aged; Nitrogen Dioxide; Ozone; Sulfur Dioxide; Vehicle Emissions

The authors evaluated the association between ventricular arrhythmias detected by implantable cardioverter defibrillators and ambient air pollution concentrations in the hours immediately before the arrhythmia. Patients given implantable cardioverter defibrillators at the New England Medical Center in Boston, Massachusetts, between mid-1995 and 1999 who lived within 40 km of a central monitoring site (n = 203) were followed until July 2002. The authors used a case-crossover design to study the association between ambient air pollution and up to 798 confirmed ventricular arrhythmias among 84 subjects. The authors found that interquartile range increases in 24-hour moving average particulate matter less than 2.5 mum in aerodynamic diameter and ozone were associated with 19% and 21% increased risks of ventricular arrhythmia, respectively. For each, there was evidence of a linear exposure response, and the associations appeared independent. These associations were stronger than associations with mean concentrations on the same calendar day and previous calendar days. The authors did not find associations with pollutant concentrations less than 24 hours before the arrhythmia. Cases with a prior ventricular arrhythmia within 72 hours had greater risk associated with air pollutants than did cases without a recent arrhythmia. These results confirm previous findings and suggest that matching of pollution periods to arrhythmias is important in detecting such associations.

Topics: Aged; Air Pollution; Arrhythmias, Cardiac; Causality; Female; Humans; Male; Massachusetts; Middle Aged; Nitrogen Dioxide; Odds Ratio; Ozone; Sulfur Dioxide; Ventricular Dysfunction

We examined whether ischemic heart disease (IHD) hospital admissions were associated with air pollutants in those with and without secondary diagnoses of arrhythmia (ARR) or congestive heart failure (CHF). We assessed the occurrence of increased vulnerability among persons with these conditions to daily variations in ozone, carbon monoxide, nitrogen dioxide, or particulate matter less than or equal to 10 micro m in aerodynamic diameter (PM10). The study population consisted of members of a large health maintenance organization residing in the South Coast Air Basin of California from 1988 to 1995. After adjustment for day of week, study year, and smoothing splines for day of study, temperature, and relative humidity, CO and NO2 were both associated with admissions with the greatest effects for CO. A 1-ppm increase in 8-hr average CO was associated with a 3.60% [95% confidence interval (CI), 1.62-5.63%] increase in same-day IHD admissions in persons with a secondary diagnosis of CHF, a 2.99% (95% CI, 1.80-4.19%) increase in persons with a secondary diagnosis of ARR, and a 1.62% (95% CI, 0.65-2.59%) increase in IHD admissions in persons without either secondary diagnosis. Air pollution was most strongly associated with myocardial infarction hospital admissions. The vulnerability of the secondary CHF subgroup may be due to a greater prevalence of myocardial infarction primary diagnoses and not the modifying effect of CHF. This study suggests that people with IHD and accompanying CHF and/or ARR constitute a sensitive subgroup in relation to the effects of criteria ambient air pollutants associated with motor vehicle combustion.

Topics: Aged; Air Pollutants; Arrhythmias, Cardiac; Carbon Monoxide; Epidemiologic Studies; Female; Heart Failure; Humans; Incidence; Male; Middle Aged; Myocardial Ischemia; Nitrogen Dioxide; Oxidants, Photochemical; Ozone; Particle Size; Patient Admission; Risk Factors; Vehicle Emissions

Air pollution episodes have been associated with increased cardiovascular hospital admissions and mortality in time-series studies. We tested the hypothesis that patients with implanted cardioverter defibrillators experience potentially life-threatening arrhythmias after such air pollution episodes. We compared defibrillator discharge interventions among 100 patients with such devices in eastern Massachusetts, according to variations in concentrations of particulate matter, black carbon, and gaseous air pollutants that were measured daily for the years 1995 through 1997. A 26-ppb increase in nitrogen dioxide was associated with increased defibrillator interventions 2 days later (odds ratio = 1.8; 95% confidence interval = 1.1-2.9). Patients with ten or more interventions experienced increased arrhythmias in association with nitrogen dioxide, carbon monoxide, black carbon, and fine particle mass. These results suggest that elevated levels air pollutants are associated with potentially life-threatening arrhythmia leading to therapeutic interventions by an implanted cardioverter defibrillator.

Topics: Adult; Aged; Aged, 80 and over; Air Pollutants; Air Pollution; Arrhythmias, Cardiac; Carbon; Carbon Monoxide; Defibrillators, Implantable; Disease Progression; Electric Countershock; Female; Hospitalization; Humans; Incidence; Male; Massachusetts; Middle Aged; Nitrogen Dioxide; Odds Ratio; Retrospective Studies; Sulfur Dioxide; Survival Rate