Life-threatening arrhythmias are more common on days with heavily polluted air, according to a study presented today at the European Society of Cardiology (ESC) Heart Failure 2022.1. and conducting rescue therapy.
“Our study shows that people at high risk for ventricular arrhythmias, such as IBD, should check their daily pollution levels,” said study author Dr. Alessia Zani, who now works at Maggiore Hospital in Bologna and formerly at Piacenza Hospital. , Italy. “When specific substance concentrations (PM) 2.5 and PM 10 are high (above 35 μg / m)3 and 50 μg / m3, respectively), it would be wise to stay indoors as much as possible and wear the N95 mask outdoors, especially in places with heavy traffic. You can use an air purifier at home. “
The World Health Organization estimates that outdoor pollution kills about 4.2 million people annually.2 Nearly one in five deaths from cardiovascular disease is due to dirty air, which has become the fourth risk factor for deaths after high blood pressure, tobacco use and poor nutrition.3
This study investigated the link between air pollution and ventricular arrhythmia in Piacenza, northern Italy. The European Environment Agency ranked the city in the 307 worst of 323 cities on average annual concentrations of PM2.5 in 2019 and 2020 with a rate of 20.8 mcg / m3.
“We noticed that visits to the emergency department for arrhythmias in patients with ICDs were usually collected on days with particularly high air pollution,” said Dr. Zani. “Therefore, we decided to compare the concentration of air pollutants on days when patients had arrhythmias, with the level of pollution on days without arrhythmias.”
The study included 146 consecutive patients who received IBD between January 2013 and December 2017. Of these, 93 received IBD due to heart failure after a heart attack, and 53 had genetic or inflammatory heart disease. Slightly more than half (79 patients) had never experienced ventricular arrhythmia, and 67 patients had previously had ventricular arrhythmia.
Data on ventricular arrhythmias (ventricular tachycardia and ventricular fibrillation) were collected remotely from the ICD until the study was completed in late 2017. Researchers also recorded therapy conducted by the device. This included antitachycardia for ventricular tachycardia (increased heart rate), which delivers electrical impulses to the heart muscle to restore normal heart rate and rhythm. The second therapy was an electric shock to reset the heartbeat during ventricular fibrillation.
Daily levels of PM10, PM2.5, carbon monoxide (CO), nitrogen dioxide (NO2) and ozone (O3) were obtained from the monitoring stations of the Regional Environmental Protection Agency (ARPA). Patients were assigned a survey based on their home address. The researchers analyzed the relationship between the concentration of pollutants and the occurrence of ventricular arrhythmias.
A total of 440 ventricular arrhythmias were recorded during the study period, of which 322 were treated with antitachycardia and 118 with shock. The researchers found a significant association between PM2.5 levels and ventricular arrhythmias treated with shock, corresponding to a 1.5% increase in risk with each increase in PM2.5 by 1 μg / m3. They also found that if PM2.5 concentrations were increased by 1 μg / m3 throughout the week compared to mean levels, the probability of ventricular arrhythmia was 2.4% higher, regardless of temperature. If PM10 was 1 μg / m3 above average during the week, the risk of arrhythmias was increased by 2.1%.
Dr Zani said: “Particles can cause acute inflammation of the heart muscle, which can serve as a trigger for cardiac arrhythmias. Because these toxic particles are emitted from power plants, industry and cars, green health projects are needed that people can take to protect themselves ».
She concluded: “These data confirm that environmental pollution is not only an emergency in the climate, but also a health problem. The study shows that the survival of patients with heart disease is affected not only by pharmacological therapy and advances in cardiology. but also the air. that they breathe. In this battle, an alliance can be won between scientific societies and politicians to protect not only the environment but also the health of the human population. “
1The abstract “Exposure to small solid particles and the risk of ventricular arrhythmia in patients with IBD” will be presented during the session “Electronic posters in heart failure – the focus of arrhythmia and devices”, which will be held on May 21.
2World Health Organization: https://www.who.int/health-topics/air-pollution#tab=tab_2.
3Brewer M., Casadei B., Harrington R.A., et al. Opposition to air pollution – the impact on cardiovascular disease. Eur Heart J.. 2021; 42: 1460-1463.