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Associations between arrhythmia episodes and temporally and spatially resolved black carbon and particulate matter in elderly patients
  1. Antonella Zanobetti1,
  2. Brent A Coull2,
  3. Alexandros Gryparis3,
  4. Itai Kloog1,4,
  5. David Sparrow5,
  6. Pantel S Vokonas5,
  7. Robert O Wright1,6,
  8. Diane R Gold1,6,
  9. Joel Schwartz1
  1. 1Environmental Epidemiology and Risk Program, Harvard School of Public Health, Boston, Massachusetts, USA
  2. 2Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts, USA
  3. 3Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
  4. 4The Department of Geography and Environmental Development, Ben-Gurion University of the Negev, Beer Sheva, Israel
  5. 5Department of Medicine, VA Normative Aging Study, Veterans Affairs Boston Healthcare System, Boston University School of Medicine, Boston, Massachusetts, USA
  6. 6Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
  1. Correspondence to Dr Antonella Zanobetti, Department of Environmental Health, Exposure Epidemiology and Risk Program, Harvard School of Public Health, 401 Park Drive, Landmark Center, Suite 415, P.O. Box 15698, Boston, MA 02215, USA; azanobet{at}


Objectives Ambient air pollution has been associated with sudden deaths, some of which are likely due to ventricular arrhythmias. Defibrillator discharge studies have examined the association of air pollution with arrhythmias in sensitive populations. No studies have assessed this association using residence-specific estimates of air pollution exposure.

Methods In the Normative Aging Study, we investigated the association between temporally resolved and spatially resolved black carbon (BC) and PM2.5 and arrhythmia episodes (bigeminy, trigeminy or couplets episodes) measured as ventricular ectopy (VE) by 4 min ECG monitoring in repeated measures of 701 subjects, during the years 2000–2010. We used a binomial distribution (having or not a VE episode) in a mixed effect model with a random intercept for subject, controlling for seasonality, temperature, day of the week, medication use, smoking, having diabetes, body mass index and age. We also examined whether these associations were modified by genotype or phenotype.

Results We found significant increases in VE with both pollutants and lags; for the estimated concentration averaged over the 3 days prior to the health assessment, we found increases in the odds of having VE with an OR of 1.52 (95% CI 1.19 to 1.94) for an IQR (0.30 μg/m3) increase in BC and an OR of 1.39 (95% CI 1.12 to 1.71) for an IQR (5.63 μg/m3) increase in PM2.5. We also found higher effects in subjects with the glutathione S-transferase theta-1 and glutathione S-transferase mu-1 variants and in obese (p<0.05).

Conclusions Increased levels of short-term traffic-related pollutants may increase the risk of ventricular arrhythmia in elderly subjects.

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