Abstract
Air pollution is commonly defined as the contamination of the air we breathe by any chemical, physical or biological agent that is potentially threatening to human and ecosystem health. The common pollutants known to be disease-causing are particulate matter, ground-level ozone, sulphur dioxide, nitrogen dioxide and carbon monoxide. Although the association between increasing concentrations of these pollutants and cardiovascular disease is now accepted, the association of air pollution and arrhythmias is less well-established. This review provides an in-depth discussion of the association between both acute and chronic air pollution exposure and arrhythmia incidence, morbidity and mortality, and the purported pathophysiological mechanisms. Increases in concentrations of air pollutants have multiple proarrhythmic mechanisms including systemic inflammation (via increases in reactive oxygen species, tumour necrosis factor and direct effects from translocated particulate matter), structural remodelling (via an increased risk of atherosclerosis and myocardial infarction or by affecting the cell-to-cell coupling and gap junction function), and both mitochondrial and autonomic dysfunction. Furthermore, this review will describe the associations between air pollution and arrhythmias. There is a strong correlation between acute and chronic air pollutant exposure and the incidence of atrial fibrillation. Acute increases in air pollution increase the risk of emergency room visits and hospital admissions for atrial fibrillation and both the risk of stroke and mortality in patients with atrial fibrillation. Similarly, there is a strong correlation between increases of air pollutants and the risk of ventricular arrhythmias, out-of-hospital cardiac arrest and sudden cardiac death.
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