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  • Association of ventricular arrhythmias detected by implantable cardioverter defibrillator and ambient air pollutants in the St Louis, Missouri metropolitan area

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Original article
Association of ventricular arrhythmias detected by implantable cardioverter defibrillator and ambient air pollutants in the St Louis, Missouri metropolitan area
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  1. D Q Rich1,
  2. M H Kim2,
  3. J R Turner3,
  4. M A Mittleman4,
  5. J Schwartz1,
  6. P J Catalano5,
  7. D W Dockery1
  1. 1Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA
  2. 2Regions Hospital & University of Minnesota, St Paul, MN, USA
  3. 3Department of Chemical Engineering, Washington University, St Louis, MO, USA
  4. 4Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, MA, USA
  5. 5Department of Biostatistical Science, Dana-Farber Cancer Institute, Boston, MA, USA
  1. Correspondence to:
 Dr D W Dockery
 Harvard School of Public Health, Department of Environmental Health, Landmark Suite 415, 401 Park Drive West, Boston, MA 02115, USA; ddockery{at}hsph.harvard.edu

Abstract

Background: 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.

Aims: To assess the association of community exposures to air pollution with ventricular arrhythmias in a cohort of ICD patients in metropolitan St Louis, Missouri.

Methods: 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.

Results: 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 μg/m3), respectively in the 24 hours before the arrhythmia.

Conclusions: 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.

  • air pollution
  • epidemiology
  • ventricular arrhythmia
  • implantable cardioverter defibrillator
  • case-crossover

https://doi.org/10.1136/oem.2005.023457

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    Footnotes

    • Published Online First 12 May 2006

    • Funding: This study was funded in part by a National Institute of Environmental Health Sciences program project grant (NIEHS ES-09825) and the Harvard National Institute of Environmental Health Sciences Center for Environmental Health (NIEHS ES00002). Air pollution measurements were funded in part by the EPA St Louis–Midwest Supersite (USEPA Cooperative Agreement R-82805901-0 and Grant X-98722301-0), EPA/Harvard Center on Ambient Particle Health Effects (USEPA Grant R827353), and the Electric Power Research Institute (EPRI Grant W09207-02). Dr David Rich received support from NIEHS Grant # T32 E207069.

    • Competing interests: MHK has been a consultant/speaker for Medtronic and has had research funding with Medtronic, Guidant, and St Jude Medical. JRT has received research funding from the Electric Power Research Institute (EPRI).

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