Acute adverse effects of fine particulate air pollution on ventricular repolarization

BACKGROUND: The mechanisms for the relationship between particulate pollution and cardiac disease are not fully understood. OBJECTIVE: We examined the effects and time course of exposure to fine particulate matter ≤ 2.5 μm in aerodynamic diameter (PM_2.5) on ventricular repolarization of 106 nonsmoking adults who were living in communities in central Pennsylvania. METHODS: The 24-hr beat-to-beat electrocardiogram (ECG) data were obtained using a high-resolution 12-lead Holter system. After visually identifying and removing artifacts and arrhythmic beats, we summarized normal beat-to-beat QTs from each 30-min segment as heart rate (HR)-corrected QT measures: QT prolongation index (QTI), Bazett's HR-corrected QT (QTcB), and Fridericia's HR-corrected QT (QTcF). A personal PM_2.5 monitor was used to measure individual-level real-time PM_2.5 exposures for 24 hr. We averaged these data and used 30-min time-specific average PM_2.5 exposures. RESULTS: The mean age of the participants was 56 ± 8 years, with 41% male and 74% white. The means ± SDs for QTI, QTcB, and QTcF were 111 ± 6.6, 438 ± 23 msec, and 422 ± 22 msec, respectively; and for PM_2.5, the mean ± SD was 14 ± 22 μg/m³. We used distributed lag models under a framework of linear mixed-effects models to assess the autocorrelation-corrected regression coefficients between (β) between 30-min PM_2.5 and the HR-corrected QT measures. Most of the adverse ventricular repolarization effects from PM_2.5 exposure occurred within 3-4 hr. The multivariable adjusted β(SE, p-value) due to a 10-μg/m³ increase in lag 7 PM_2.5 on QTI, QTcB, and QTcF were 0.08 (0.04, p < 0.05), 0.22 (0.08, p < 0.01), and 0.09 (0.05, p < 0.05), respectively. CONCLUSIONS: Our results suggest a significant adverse effect of PM_2.5 on ventricular repolarization. The time course of the effect is within 3-4 hr of elevated PM_2.5.