Iranian Heart Journal

Iranian Heart Journal

Impact of Air Pollution on Cardiac Arrhythmia in Patients With Implantable Cardiac Defibrillators

Document Type : Original Article

Authors
Mahboubeh Ekramifard 1
Leila Bigdelu 1
Yousef Dowlatabadi 2
Mohammad Tayyebi 1
Habibollah Esmaili 3
Ali Hadianfar 4
Ali Eshraghi 1
Mohammad Mahdi Ekramifard 2
1 Vascular and Endovascular Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, IR Iran.
2 School of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran.
3 Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, IR Iran.
4 Department of Epidemiology and Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, IR Iran.
Abstract
Objective: Cardiac arrhythmia, a disruptor of heart rhythm, can increase hospitalizations and mortality. This study explored the impact of air pollution on arrhythmia incidence among patients with implantable cardioverter-defibrillators (ICDs) in Mashhad, Iran, and its potential influence on their quality of life and risk of out-of-hospital cardiac arrest.
 
Methods: In 2018, a study was conducted on patients with ICDs from Imam Reza Hospital. Patients were assigned to an air pollution monitoring station based on their residential address. Arrhythmia data were collected from device interrogations during follow-up visits. A checklist was used to record meteorological data, unhealthy weather days, and levels of carbon monoxide (CO), nitrogen dioxide (NO2), sulfur dioxide (SO2), and particulate matter (PM10 and PM2.5). The correlation between arrhythmia and air pollutants was analyzed using time-series and spatial data analyses.
 
Results: The study involved 194 patients (mean [SD] age =63.14 [12.34] years; 167 men and 27 women). The primary indication for ICD implantation was ischemic cardiomyopathy (70%), followed by dilated cardiomyopathy (18.6%). A total of 1163 cardiac arrhythmias were recorded, with 70% being ventricular and 30% supraventricular. A significant association was identified between the overall count of cardiac arrhythmias and the levels of NO2 (P =0.034), PM2.5 (P =0.03), and CO (P =0.004). Conversely, the concentrations of SO2 and PM10 did not have a substantial impact on total arrhythmia occurrences. These findings imply that air pollutants such as NO₂, PM2.5, and CO could potentially jeopardize cardiac health.
 
Conclusions: We concluded that air pollutants, specifically NO2, CO, and PM2.5, influence the occurrence of cardiac arrhythmia in high-risk groups such as patients with ICDs. The findings highlight the urgent need for comprehensive strategies to mitigate air pollution to reduce the risk of cardiac arrhythmias in vulnerable populations. (Iranian Heart Journal 2025; 26(4): 22-33)
Keywords
Implantable cardioverter-defibrillator
Cardiac arrhythmia
Air pollution
Air pollutants
Particulate matter
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Iranian Heart Journal
Volume 26, Issue 4
Autumn 2025
Pages 22-33