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Cardiac arrhythmia emergency room visits and environmental air pollution in São Paulo, Brazil
  1. U P Santos1,
  2. M Terra-Filho1,
  3. C A Lin2,3,
  4. L A A Pereira2,4,
  5. T C B Vieira2,
  6. P H N Saldiva2,
  7. A L F Braga2,4,5
  1. 1
    Pulmonary Division of Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
  2. 2
    Environmental Epidemiology Study Group, Laboratory of Experimental Air Pollution, University of São Paulo Medical School, São Paulo, Brazil
  3. 3
    Department of Internal Medicine, University of São Paulo Medical School, São Paulo, Brazil
  4. 4
    Collective Health Postgraduation Program, Catholic University of Santos, Brazil
  5. 5
    Environmental Pediatrics Program, University of Santo Amaro Medical School, São Paulo, Brazil
  1. Alfésio Luís Ferreira Braga, Rua Francisco Octávio Pacca, 180, 4° Andar, Grajaú, São Paulo, CEP 04822-320, Brazil; abraga{at}


Objectives: Air-pollution exposure has been associated with increased cardiovascular hospital admissions and mortality in time-series studies. We evaluated the relation between air pollutants and emergency room (ER) visits because of cardiac arrhythmia in a cardiology hospital.

Methods: In a time-series study, we evaluated the association between the emergency room visits as a result of cardiac arrhythmia and daily variations in SO2, CO, NO2, O3 and PM10, from January 1998 to August 1999. The cases of arrhythmia were modelled using generalised linear Poisson regression models, controlling for seasonality (short-term and long-term trend), and weather.

Results: Interquartile range increases in CO (1.5 ppm), NO2 (49,5 µg/m3) and PM10 (22.2 µg/m3) on the concurrent day were associated with increases of 12.3% (95% CI: 7.6% to 17.2%), 10.4% (95% CI: 5.2% to 15.9%) and 6.7% (95% CI: 1.2% to 12.4%) in arrhythmia ER visits, respectively. PM10, CO and NO2 effects were dose-dependent and gaseous pollutants had thresholds. Only CO effect resisted estimates in models with more than one pollutant.

Conclusions: Our results showed that air pollutant effects on arrhythmia are predominantly acute starting at concentrations below air quality standards, and the association with CO and NO2 suggests a relevant role for pollution caused by cars.

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  • Funding: The study was supported by the universities listed in the authors’ affiliations.

  • Competing interests: None.

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