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The environmental epidemiology of atrial arrhythmogenesis
  1. Eric A Whitsel1,2,
  2. Christy L Avery1
  1. 1University of North Carolina, Gillings School of Global Public Health, Department of Epidemiology, Chapel Hill, North Carolina, USA
  2. 2University of North Carolina, School of Medicine, Department of Medicine, Chapel Hill, North Carolina, USA
  1. Correspondence to Eric A Whitsel, University of North Carolina, Chapel Hill, Departments of Epidemiology and Medicine, Cardiovascular Disease Program, Bank of America Center, Suite 306-E, 137 East Franklin Street, Chapel Hill, NC 27514, USA; ewhitsel{at}


Atrial fibrillation (AF) is the most common cardiac arrhythmia seen in clinical practice, and makes an important contribution to cardiovascular disease (CVD) and all-cause mortality. The focus of AF research has recently shifted, from concentrating on treatments and complications, to the evaluation of putative risk factors including ambient air pollution. Although the present study pertains specifically to AF, much of its content is drawn from, and therefore is applicable to, the study of other arrhythmias, the conduct of which is confronted by many of the same challenges. Meeting these challenges involves recognising the collective importance of 1. large, ethnically and geographically diverse, clinically well-characterised populations; 2. methods for reducing uncertainty in outcome ascertainment, distinguishing effects of pervasive environmental exposures and improving their estimation; 3. approaches to evaluation of susceptibility; and 4. strategies for informing regulatory policies designed to help control population-level risks for CVD.

  • Air pollution
  • epidemiology
  • electrocardiography
  • arrhythmia
  • atrial fibrillation
  • heart disease

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  • Funding Preparation of this paper was supported in part by grants R01-ES012238 and T32-HL007055 from the National Institute of Environmental Health Sciences (NIEHS) and National Heart, Lung and Blood Institute (NHLBI). The conclusions presented herein are those of the authors and do not necessarily represent those of the NIEHS or NHLBI.

  • Competing interests None.

  • Provenance and peer review Commissioned; externally peer reviewed.