Association of short- and long-term exposure to air pollution with atrial fibrillation

Background Atrial fibrillation is a common cardiac arrhythmia and an important risk factor for stroke and cardiovascular morbidity. However, there is limited evidence regarding the association of air pollution with atrial fibrillation. This study aimed to compare the short-term and long-term effects of air pollution on atrial fibrillation. Design A nationwide cohort from the Korean general population. Methods Different analytical approaches were used for short-term and long-term effects. For the analysis of short-term effects, the daily incidence of emergency admissions for atrial fibrillation was identified. The relationship of atrial fibrillation with air pollutants, including PM2.5 (particulate matter ≤ 2.5 μm in aerodynamic diameter), PM10, carbon monoxide, sulphur dioxide, nitrogen dioxide and ozone, was analysed using a time-series analysis. The long-term effects of air pollution were analysed for subjects aged ≥30 years who resided in Seoul between 2007 and 2015 and had no history of atrial fibrillation. Results During the study period, 1137 emergency visits were identified in Seoul as being associated with atrial fibrillation. A 10-μg/m3 increase in ambient PM2.5 was shown to significantly increase emergency admissions by 4.5% at lag day 3 (p = 0.038). No other pollutants showed a significant relationship with emergency atrial fibrillation admission. Among 124,010 residents in Seoul, 1903 developed atrial fibrillation at a median follow-up of 9.5 years (1.95 per 1000 person-years). Long-term exposure to air pollution had no significant impact on atrial fibrillation occurrence (p = 0.830 for PM2.5). Conclusion This study suggests that short-term exposure to PM2.5 triggers atrial fibrillation. However, we found no evidence linking atrial fibrillation with long-term exposure to air pollution.