Air Pollution and ICD-Detected Cardiac Arrhythmias

空气污染和 ICD 检测到的心律失常

• 批准号: 7508986
• 负责人: Douglas W Dockery
• 金额: $ 20.19万
• 依托单位: HARVARD SCHOOL OF PUBLIC HEALTH
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/7508986
• 关键词: Acute; Air Pollution; Andro-Diane; Area; Arrhythmia; Biochemical; Boston; Cardiac; Cardiovascular system; Clinical; Congestive Heart Failure; Coronary; Data; Defibrillators; Depressed mood; Devices; Diagnosis; Diagnostic; End Point; Enrollment; Epidemiologic Studies; Event; Exposure to; Goals; Gold; Heart Atrium; Hour; Implant; Inflammation; Life; Medical; Methods; Monitor; Morbidity - disease rate; New England; Numbers; Outcome; Particulate; Patients; Physiological; Pollution; Regulation; Research Personnel; Research Project Grants; Risk; Subgroup; Sudden Death; Supraventricular Arrhythmia; Tachyarrhythmias; Testing; Ventricular; Ventricular Arrhythmia; day; design; experience; improved; mortality; particle; programs

Epidemiologic studies have found an association between short-term increases in particulate air pollution and cardiovascular morbidity and mortality. Our Program Project goal is to understand the relation of particle pollution to clinical, physiologic and biochemical endpoints reflecting potential mechanisms underlying these associations. In this Research Project we have focused on endpoints influenced by autonomic regulation. We have found that short-term exposure to ambient air pollution is associated with increased risk of ventricular arrhythmias in patients with Implanted Cardioverter Defibrillators (ICD). Although the study was not originally designed to detect supraventricular arrhythmias, we found the risk of these events also was associated with air pollution episodes. Improvements in ICD diagnostic capabilities have increased their utility for such studies. Most current ICDs have dual chamber monitoring, allowing more specific definition of ventricular versus atrial tachyarrhythmias. A growing number of Coronary Resynchronization Therapy ICD devices are being implanted in congestive heart failure patients, a group particularly susceptible to sudden death from arrhythmias. We propose to enroll 400 Boston area patients with dual chamber ICDs being followed at Tufts-New England Medical. We will prospectively follow these patients for an average of three years recording confirmed episodes of acute ventricular and supraventricular tachyarrhythmias, with improved definition of our arrhythmia outcomes. Using case-crossover methods, we will assess the risk of ventricular and supraventricular tachyarrhythmias with ambient air pollution concentrations in the hours and days prior to these arrhythmias. Enhanced pollution exposure monitoring will enable us to characterize differentiate effects of particle components, with improved assessment of spatial as well as temporal differences in exposure. Finally, we will assess if this risk is greater in susceptible subgroups including patients with elevated systemic inflammation, depressed vagal tone, or a diagnosis of congestive heart failure.

流行病学研究发现颗粒物空气污染的短期增加与心血管疾病发病率和死亡率之间存在关联。我们的项目目标是了解颗粒污染与临床、生理和生化终点的关系，反映这些关联背后的潜在机制。在这个研究项目中，我们重点关注受自主调节影响的终点。我们发现，短期暴露于环境空气污染与植入式心脏复律除颤器 (ICD) 患者室性心律失常的风险增加相关。尽管该研究最初的目的不是检测室上性心律失常，但我们发现这些事件的风险也与空气污染事件有关。 ICD 诊断能力的改进提高了其诊断能力 此类研究的实用性。目前大多数 ICD 都具有双腔监测功能，可以更具体地定义心室与房性快速心律失常。越来越多的冠状动脉再同步治疗 ICD 装置被植入充血性心力衰竭患者，这一群体特别容易因心律失常猝死。我们建议招募 400 名波士顿地区佩戴双腔 ICD 的患者，并在塔夫茨-新英格兰医疗中心接受随访。我们将前瞻性地跟踪这些患者平均三年，记录已确诊的急性室性和室上性快速心律失常的发作，并改进对急性室性和室上性心律失常的定义。 我们的心律失常结果。使用病例交叉方法，我们将评估室性和室上性快速心律失常的风险以及心律失常发生前数小时和数天内的环境空气污染浓度。加强污染暴露监测将使我们能够表征颗粒成分的不同影响，并改进对暴露的空间和时间差异的评估。最后，我们将评估这种风险在易感亚组中是否更大，包括全身炎症升高、迷走神经张力降低或诊断为充血性心力衰竭的患者。