Impact of particulate matter on the incidence of atrial fibrillation and the risk of adverse clinical outcomes: A review

Background: Atrial fibrillation (AF) is common and increases the risk of stroke and mortality. Previous studies have sug-gested that air pollution is an important risk factor for new-onset AF. Herein, we review the evidence regarding: 1) the association between exposure to particulate matter (PM) and new-onset AF, and 2) the risk of worse clinical outcomes in patients with pre-existent AF and their relation to PM exposure.Methods: A selection of studies between 2000 and 2023 linking PM exposure and AF was performed through searches in PubMed, Scopus, Web of Science, and Google Scholar.Results: 17 studies from different geographical areas demonstrated that exposure to PM was associated with an in-creased risk of new-onset AF, although the results were heterogeneous regarding the temporal pattern (short-or long-term) ultimately related to AF. Most of the studies concluded that the risk of new-onset AF increased between 2 %-18 % per 10 mu g/m3 increment in PM2.5 or PM10 concentrations, whereas the incidence (percentage of change of incidence) increased between 0.29 %-2.95 % per 10 mu g/m3 increment in PM2.5 or PM10. Evidence about the asso-ciation between PM and adverse events in patients with pre-existent AF was scarce but 4 studies showed a higher risk of mortality and stroke (between 8 %-64 % in terms of hazard ratio) in patients with pre-existent AF when PM expo-sure was higher.Conclusions: Exposure to PM (both PM2.5 and PM10) is a risk factor for AF, and a risk factor for mortality and stroke in patients who already suffer from AF. Since the relationship between PM and AF is independent of the region of the world, PM should be considered as a global risk factor for both AF and worse clinical outcomes in AF patients. Specific measures to prevent air pollution exposure need to be adopted.

Automated summary

This review examines the association between exposure to particulate matter (PM) and the onset of atrial fibrillation (AF), as well as the risk of adverse clinical outcomes in patients with pre-existent AF. The findings indicate that exposure to PM increases the risk of new-onset AF, as well as mortality and stroke in AF patients. Therefore, PM should be considered a global risk factor for AF and worse clinical outcomes in AF patients, and specific measures to prevent air pollution exposure should be implemented.