| Association of Air Pollution with Increased Incidence of Ventricular Tachyarrhythmias Recorded by Implanted Cardioverter Defibrillators Douglas W. Dockery,1,2 Heike Luttmann-Gibson,1 David Q. Rich,1 Mark S. Link,3 Murray A. Mittleman,4,5 Diane R. Gold,1,2 Petros Koutrakis,1 Joel D. Schwartz,1,2 and Richard L. Verrier1,5 1Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, USA; 2Channing Laboratory, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA; 3New England Medical Center, Tufts University, Boston, Massachusetts, USA; 4Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA; 5Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA Abstract
Epidemiologic studies have demonstrated a consistent link between sudden cardiac deaths and particulate air pollution. We used implanted cardioverter defibrillator (ICD) records of ventricular tachyarrhythmias to assess the role of air pollution as a trigger of these potentially life-threatening events. The study cohort consisted of 203 cardiac patients with ICD devices in the Boston metropolitan area who were followed for an average of 3.1 years between 1995 and 2002. Fine particle mass and gaseous air pollution plus temperature and relative humidity were measured on almost all days, and black carbon, sulfate, and particle number on a subset of days. Date, time, and intracardiac electrograms of ICD-detected arrhythmias were downloaded at the patients' regular follow-up visits (about every 3 months) . Ventricular tachyarrhythmias were identified by electrophysiologist review. Risk of ventricular arrhythmias associated with air pollution was estimated with logistic regression, adjusting for season, temperature, relative humidity, day of the week, patient, and a recent prior arrhythmia. We found increased risks of ventricular arrhythmias associated with 2-day mean exposure for all air pollutants considered, although these associations were not statistically significant. We found statistically significant associations between air pollution and ventricular arrhythmias for episodes within 3 days of a previous arrhythmia. The associations of ventricular tachyarrhythmias with fine particle mass, carbon monoxide, nitrogen dioxide, and black carbon suggest a link with motor vehicle pollutants. The associations with sulfate suggest a link with stationary fossil fuel combustion sources. Key words: air pollution, arrhythmias, epidemiology, fibrillation, heart arrest. Environ Health Perspect 113:670-674 (2005) . doi:10.1289/ehp.7767 available via http://dx.doi.org/ [Online 18 February 2005]
Address correspondence to D.W. Dockery, Exposure, Epidemiology and Risk Program, Department of Environmental Health, Harvard School of Public Health, Landmark Center, Room 415D West, P.O. Box 15677, 401 Park Dr., Boston, MA 02215 USA. Telephone: (617) 384-8740. Fax: (617) 384-8745. E-mail: ddockery@hsph.harvard.edu We thank the data abstracters, including J. Baliff, C. Freed, C. Hu, R. Hulefeld, and L. McClelland. The Health Effects Institute (grant 98-14) and the National Institute of Environmental Health Sciences (ES-09825 and ES-00002) funded this study. Particulate air pollution measurements were supported in part by the U.S. Environmental Protection Agency (grant R827353) . The authors declare they have no competing financial interests. Received 17 November 2004 ; accepted 14 February 2005. Correction Some counts of observations (Tables 1 and 2) and the interquartile range of SO4 (Tables 1, 2, and 3) were for 1-day rather than 2-day mean in the original manuscript published online. They have been corrected here.
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