Introduction and objective:
Air pollution is the largest environmental health risk, estimated to cause over 5 million premature deaths per year worldwide, including half million deaths in Europe. It is associated with significant reductions in healthy life years and worker productivity. It may also be an important endocrine disrupter, contributing to the development of metabolic diseases such as obesity and diabetes mellitus and due to acute ischaemic/thrombotic cardiovascular events. Aim of the study was to present the current knowledge on short- and long-term exposure to air pollution, including particulate matter (PM2.5 and PM10) and the occurrence of atrial fibrillation (AF).

Review methods:
The review article was based on data obtained from articles published in the PubMed or related databases. We searched observational studies.

Abbreviated description of the state of knowledge:
Some of the studies demonstrated a triggering effect of exposure to air pollution on acute exacerbation of atrial fibrillation. Evidence for a long-term effect of air pollution exposure on AF episodes is even more scarce or limited.

Data indicate that human exposure to air pollution is associated with an increased risk of atrial fibrillation. Studies confirmed that further efforts to reduce air pollution exposure should be undertaken to reduce the negative health effects in the general population. To better understand the effect of air pollution on incidence of AF and the related public health impact in the most polluted regions of the world, more high-quality studies are needed.

Forouzanfar MH, Aleksander L, Anderson HR, et al. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries. 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;386(10010):2287–2323. doi:10.1016/S0140-6736(15)00128-2.
EEA. Air quality in Europe – 2014 Report. EEA Report No 5/2014. European Environment Agency, Copenhagen. doi:10.2800/22775.
Zivin JG, Neidell M. Air pollution’s hidden impacts. Science. 2018;359(6371):39–40. doi:10.1126/science.aap7711.
Brook RD, Newby DE, Rajagopalan S. The global threat of outdoor ambient air pollution to cardiovascular health: time for intervention. JAMA Cardiol. 2017;2(4):353–354. doi:10.1001/jamacardio.2017.0032.
Krzeszowiak J, Pawlas K. Particulate matter (PM2,5 and PM10), properties and epidemiological siginificance for respiratory and cardiovascular diseases. A review of the literature on the effects of short- and long-term exposure. Med Srod. 2018;21(2):7–13. doi:10.19243/2018201.
Nattel S, Harada M. Atrial remodelling and atrial fibrillation: Recent advances and translational perspectives. J Am Coll Cardiol. 2014;63(22):2335–2345. doi:10.1016/j.jacc.2014.02.555.
Gorenek B, Pelliccia A, Benjamin EJ, et al. European Heart Rhythm Association (EHRA)/European Association of Cardiovascular Prevention and Rehabilitation (EACPR) position paper on how to prevent atrial fibrillation endorsed by the Heart Rhythm Society (HRS) and Asia Pacific Heart Rhythm Society (APHRS). Europace. 2017;19(2):190–225. doi:10.1093/europace/euw242.
Larsson SC, Drca N, Wolk A. Alcohol consumption and risk of atrial fibrillation: A prospective study and dose – response meta – analysis. J Am Coll Cardiol. 2014;64(3):281–289. doi:10.1016/j.jacc.2014.03.048.
Shao Q, Liu T, Korantzopoulos P, et al. Association between air pollution and development of atrial fibrillation: A meta-analysis of observational studies. Heart Lung. 2016;45(6):557–562. doi:10.1016/j.hrtlng.2016.08.001.
Hamanaka RB, Mutlu GM. Pariculate Matter Air Pollution. Effects on the Cardiovascular system. Front Endocrinol. 2018;9:680. doi: 10.3389/fendo.2018.00680.
Liu C, Cai J, Qiao I, et al. The acute effects of fine particulate matter constituents on blood inflammation and coagulation. Environ Sci Technol. 2017;51(14):8128–8137. doi:10.1021/acs.est.7b00312.
Lucking AJ, Lundback M, Mills NL, et al. Diesel exhaust inhalation increases thrombus formation in man. Eur Heart J. 2008;29(24):3043–3051. doi: 10.1093/eurheartj/ehn464.
Dadvand P, Ostro B, Amato F, et al. Particulate air pollution and preeclampsia: a source-based analysis. Occup Environ Med. 2014;71(8):570–577. doi: 10.1136/oemed-2013-101693.
Leary PJ, Kaufman JD, Barr RG, et al. Traffic – related air pollution and the right ventricle. The multi-ethnic study of atherosclerosis. Am J Respir Crit Care Med. 2014;189:(9)1093–1100. doi: 10.1164/rccm.201312-2298OC.
Cakmak S, Dales R, Kauri LM, et al. Metal composition of fine particulate air pollution and acute changes in cardiorespiratory physiology. Environ Pollut. 2014;189:208–214. doi:10.1016/j.envpol.2014.03.004.
Franklin BA, Brook R, Arden P. Air pollution and cardiovascular disease. Curr Probl Cardiol. 2015;40(5):207–238. doi:10.1016/j.cpcardiol.2015.01.003.
Tripathi P, Deng F, Scruggs AM, et al. Variation in doses and duration of particulate matter exposure in bronchial epithelial cells results in upregulation of different genes associated with airway disorders. Toxicol In vitro. 2018;51:95–105. doi:10.1016/j.tiv.2018.05.004.
Jin X, Xue B, Zhou Q, et al. Mitochondrial damage mediated by ROS incurs bronchial epithelial cell apoptosis upon ambient PM2,5 exposure. J Toxicol Sci. 2018;43(2):101–111. doi:10.2131/jts.43.101.
Marchini T, Wolf D, Michael N A, et al. Acute exposure to air pollution particulate matter aggravates experimental myocardial infarction in mice by potentiating cytokine secretion from lung macrophages. Basic Res Cardiol. 2016;111(44):1–14. doi:10.1007/s00395-016-0562-5.
Hunter CA, Jones SA. IL – 6 as a keystone cytokine in health and disease. Nat Immunol. 2015;16(5):448–457. doi:10.1038/ni.3153.
Li H, Cai J, Chen R, et al. Particulate matter exposure and stress hormone levels: a randomized, double-blind, crossover trial of air pollution. Circulation. 2017;136(7):618–627. doi:10.1161/CIRCULATIONAHA.116.026796.
Xu X, Liu C, Xu Z, et al. Long-term exposure to ambient fine particulate pollution induces insulin resistance and mitochondrial alteraration in adipose tissue. Toxicol Sci. 2011;124(1):88–98. doi:10.1093/toxsci/kfr211.
Madrigano J, Baccarelli A, Mittleman MA, et al. Prolonged exposure to particulate pollution, genes associated with glutathione pathways, and DNA methylation in cohort of older man. Environ Health Perpsect. 2011;119(7):977–982. doi:10.1289/ehp.1002773.
Baccarelli A, Wright RO, Bollati V, et al. Rapid DNA methylation changes after exposure to traffic particles. Am J Respir Crit Care Med. 2009;179(7):572–578. doi:10.1164/rccm.200807-1097OC.
Wichmann HE, Mueller W, Allhoff P, et al. Health effects during a smog episode in West Germany in 1985. Environ Helath Perspect. 1989;79:89–99. doi:10.1289/ehp.897989.
Milovjevic A, Wilkinson P, Armstrong B, et al. Short-term effects of air pollution on a range of cardiovascular events in England and Wales: case – crossover analysis of the MINAP database, hospital admissions and mortality. Heart. 2014;100(14):1093–1098. doi:10.1136/heartjnl-2013-304963.
Link MS, Luttman-Gibson H, Schwartz J, et al. Acute exposure to Air Pollution Triggers Atrial Fibrillation. J Am Coll Cardiol. 2013;62(9):816–825. doi:10.1016/j.jacc.2013.05.043.
Liu X, Kong D, Liu Y, et al. Effects of the short-term exposure to ambient air pollution on atrial fibrillation. Pacing Clin. Electrophysiol. 2018;41(11):1441–1446. doi:10.1111/pace.13500.
Folino F, Buja G, Zanotto G, et al. Association between air pollution and ventricular arrhythmias in high-risk patients (ARIA study): A multicenter longitudinal study. Lancet Planet Health. 2017;1:e58-e64. doi:10.1016/S2542-5196(17)30020-7.
Gallo E, Folino F, Buja G. Daily exposure to air pollution particulate matter is associated with atrial fibrillation in high-risk patients. Int J Environ Res Public Health. 2020;17(17):6017. doi:10.3390/ijerph17176017.
Cakmak S, Kauri L, Shutt R, et al. The association between ambient air quality and cardiac rate and rhythm in ambulatory subjects. Environ Int. 2014;73:365–371. doi:10.1016/j.envint.2014.08.015.
Kwon OK, Kim S-H, Kang S-H, et al. Associate of short- and long-term exposure to air pollution with atrial fibrillation. Eur J Prev Cardiol. 2019;26(11):1208–1216. doi:10.1177/2047487319835984.
Krzeszowiak J, Pawlas K, Rabczenko D. Effect of short-term exposure to particulate matter (PM2,5 and PM10) and its impact on sudden exacerbations of selected cardiovascular and respiratory diseases in Wrocław during 2009–2013 based on registers of ambulance emergency calls. Med Srod. 2018;22(3–4):49–56. doi:10.26444/ms/132865.
Halldorsdottir S, Finnbjornsdottir RG, Elvarsson BT, et al. Ambient nitrogen dioxide is associated with emergency hospitals visits for atrial fibrillation: a population-based case – crossover study in Reykjavik, Iceland. Environ Health. 2022;21(2):1–12. doi.10.1186/s12940-021-00817-9.
Solimini AG, Renzi M. Association between air pollution and emergency room visits for atrial fibrillation. Int J Environ Res Public Health. 2017;14(6):661. doi:10.3390/ijerph14060661.
Meng X, Liu C, Chen R, et al. Short term association of ambient nitrogen dioxide with daily total, cardiovascular and respiratory mortality: multilocation analysis in 398 cities. BMJ. 2021; 372:n534. doi:10.1136/bmj.n534.
Huang YC, Rappold AG, Graff DW, et al. Synergistic effects of exposure to concentrated to ambient the pollution particles and nitrogen dioxide in humans. Inhal Toxicol. 2012;24(12):790–797. doi:10.3109/08958378.2012.718809.
Nguyen JL, Link MS, Luttmann-Gibson H, et al. Drier air, lower temperatures, and triggering of paroxysmal atrial fibrillation. Epidemiology. 2015;26(3):374–380. doi:10.1097/EDE.0000000000000284.
Głuszak A, Kocoń S, Żuk K, et al. Episodes of atrial fibrillation and meteorological conditions. Kardiol Pol. 2008;66(9):958–963.
Culić V, Silić N, Hodzić M. Triggering of supraventricular tachycardia by physical activity and meteorologic factors. Int J Cardiol. 2013;168(4):4295–4300. doi:10.1016/j.ijcard.2013.04.195.
Giesbrecht GG. The respiratory system in a cold environment. Aviat Space Environ Med. 1995;66(9):890–902.
Larsson K, Tornling G, Gavhed D, et al. Inhalation of cold air increases the number of inflammatory cells in the lungs in healthy subjects. Eur Respir J. 1998;12(4):825–830. doi:10.1183/09031936.98.12040825.
Kupari M, Koskinen P. Seasonal variation in occurence of acute atrial fibrillation and relation to ait temperature and sale of alcohol. Am J Cardiol. 1990;66(20):1519–1520. doi:10.1016/0002-9149(90)90549-g.
Knezović M, Pintarrić S, Jelavić MM, et al. Correlation between concentration of air pollutants and occurence of cardiac arrhythmias in a region with humid continental climate. Acta Clin Croat 2017;56:3–9. doi:10.20471/acc.2017.56.01.01.
Rivera-Caravaca JM. Roldan V, Vicente V, et al. Particulate matter and temperature: Increased risk of adverse clinical outcomes in patients with atrial fibrillation. Mayo Clin Proc. 2020;95(11):2360–2369. doi:10.1016/j.mayocp.2020.05.046.
Vencloviene J, Babarskiene R M, Dobozinskas P. et al. The short-term associations of weather and air pollution with emergency ambulance calls for paroxysmal atrial fibrillation. Environ Sci Pollut Res. 2017;24:15031–15043. doi:10.1007/s11356-017-9138-7.
Kim I S, Yang P S, Lee J, et al. Long-term exposure of fine particular matter air poluution and incident atrial fibrillation in general population: A nationwide cohort study. Int J Cardiol. 2019;283:178–183. doi:10.1016/j.ijcard.2018.12.048.
Monrad M, Sajadieh A, Christensen JS, et al. Long-term exposure to traffic-related air pollution and risk of incident atrial fibrillation: a cohort study. Environ Health Perspect. 2017; 125(3):422–427. doi:10.1289/EHP392.
Schnabel RB, Yin X, Gona P, et al. 50 year trends in atrial fibrillation prevalence, incidence, risk factors, and mortality in the Framingham Heart Study. Lancet. 2015;386(9989):154–162. doi:10.1016/S0140-6736(14)61774-8.
Wolf K, Schneider A, Breitner S, et al. Association between short-term exposure to particulate matter and ultrafine particles and myocardial infarction in Augsburg, Germany. Int J Hyg Environ Health. 2015;218(6):535–542. doi:10.1016/j.ijheh.2015.05.002.
Wanahita N, Messerli F H, Bangalore S, et al. Atrial fibrillation and obesity-results of a meta-analysis. Am Heart J. 2008;155(2):310–315. doi:10.1016/j.ahj.2007.10.004.
Samokhvalov AV, Irving HM, Rehm J. Alcohol consumption as a risk factor for atrial fibrillation: a systematic review and meta-analysis. Eur J Cardiovasc Prev Rehabil. 2010;17(6):706–712. doi:10.1097/HJR.0b013e32833a1947.
Stockfelt L, Andersson EM, Molnar P, et al. Long-term effects of total and source-specific particulate air pollution on incident cardiovascular disease in Gothenburg, Sweden. Environ Res. 2017;158:61–71. doi:10.1016/j.envres.2017.05.036.
Kim IS, Sohn J, Lee SJ, et al. Association of air pollution with increased of incidence of ventricular tachyarrhythmias recorded by implantable cardioverter – defibrillators: vulnerable patients to air pollution. Int J Cardiol. 2017;240:214–220. doi:10.1016/j.ijcard.2017.03.122.
Chen M, Zhao J, Zhuo C, et al. The association between ambient air pollution and atrial fibrillation. A systematic review and meta-analysis. Int Heart J. 2021;62(2):290–297. doi:10.1536/ihj.20-523.
Yang WS, Wang X, Deng Q, et al. An evidence-based appraisal of global association between air pollution and risk of stroke. Int J Cardiol. 2014;175(2):307–313. doi:10.1016/j.ijcard.2014.05.044.
Chen SY, Lin YL, Chang WT, et al. Increasing emergency room visits for stroke by elevated levels of fine particulate constituents. Sci Total Environ. 2014;473–474:446–450. doi:10.1016/j.scitotenv.2013.12.035.
Laden F, Schwartz J, Speizer FE, et al. Reduction in fine particulate air pollution and mortality. Extended follow-up of the Harvard Six Cities Study. Am J Respir Crit Care Med. 2006;173(6):667–