Association between air pollutants and atrial fibrillation in general population: A systematic review and meta-analysis

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia with several risk factors. Recent studies have suggested that the exposure to air pollutants may increase the prevalence of AF, we evaluated those studies systematically to better elucidate the correlation between exposure to air pollution and AF. We conducted a systematic review of publications using PubMed, Embase, the Cochrane library and Web of Science to explore the association between air pollutants and AF within the general population. The chosen studies were published until 7 July 2020. According to different study designs, we divided the outcomes into “short-term-exposure group” and “long-term-exposure group” for each pollutant. We used I2 statistics and Q-test to examine statistical heterogeneity, and sensitivity analysis to exclude the heterogeneous study. Fixed or random-effect model was used to combine the effects. Final result was presented as the OR and 95% CI of AF prevalence for every 10 μg/m3 increase in the concentration of PM2.5 and PM10;10 ppb increase in the concentration of SO2 ,NO2 ,O3; and 1 ppm increase in the CO concentration. Our analysis contain 18 studies. Underlying short-term exposure effect, for each increment of 10 μg/m3 in the PM2.5 concentration, the combined OR of AF prevalence was 1.01(1.00–1.02), for PM10 was 1.03(1.01–1.05). For a 10 ppb increment in the concentration of SO2, NO2, and O3 was 1.05(1.01–1.09), 1.03(1.01–1.04), and 1.01(0.97–1.06), respectively, for a 1 ppm increase of CO concentration was 1.02(0.99–1.06). Underlying long-term-exposure effect for each increment of 10 μg/m3 in the PM2.5 concentration; the combined OR of AF prevalence was 1.07(1.04−1.10) and that for PM10 was 1.03(1.03–1.04) For a 10 ppb increment in the NO2 concentration was 1.02(1.00–1.04). Our meta-analysis indicated that all air pollutants exposure had an adverse effect on AF prevalence in general population. [Display omitted] •The first meta-analysis about the association between air pollution and atrial fibrillation in general population.•A full summary about the relevant epidemiological studies in recent years.•Subgroup analysis was used to analyze the influence of pollutants in a more detailed way.•Fills in the gaps in previous statements* and clarifies the impact of air pollution on arrhythmias.