Can air pollution trigger an onset of atrial fibrillation: a population-based study Maayan Yitshak Sade & Alina Vodonos & Victor Novack & Michael Friger & Guy Amit & Itzhak Katra & Joel Schwartz & Lena Novack Received: 8 April 2014 /Accepted: 8 September 2014 # Springer Science+Business Media Dordrecht 2014 Abstract Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia and a major risk factor for ischemic stroke. Previous data showed an effect of nitric dioxide, carbon monoxide, ozone, and particulate matter (PM) smaller than 2.5 μm in diameter on atrial fibrillation development. This study aims to evaluate the effect of air pollution on the new AF onset requiring hospitalization. A case-crossover analysis was performed on a population of patients hospitalized in a large tertiary teaching hospital between 2006 and 2010 with first life occurrence of atrial fibrillation; 1458 patients were admit- ted to the hospital with new-onset AF. AF onset was associ- ated with an interquartile range elevation of carbon monoxide concentrations during the winter season (odds ratio 1.15, p = 0.040) and sulfur dioxide concentrations during the fall season (odds ratio 1.21, p =0.028). An interquartile range elevation in nitric dioxide concentration was associated with AF onset only among patients younger than 65 years of age (odds ratio 1.08, p =0.025). Patients with diabetes mellitus or chronic obstructive pulmonary disorder had higher susceptibility for carbon monoxide-associated AF development. Short-term ex- posure to carbon monoxide, nitric dioxide, and sulfur dioxide was associated with AF onset, suggesting that these pollut- ants, originating primarily from traffic, might trigger new AF. This knowledge is essential for understanding a pathophysi- ology of the disease onset and for the development of recom- mendations for susceptible patients. Keywords Atrial fibrillation . Traffic . Air pollution . Carbon monoxide Background Approximately 4 % of US adults over 60 years of age have been diagnosed with atrial fibrillation (AF) (Go et al. 2001). Moreover, AF is a major contributor to heart failure incidence (Roy et al. 2009) and is associated with increased medical costs and all cause mortality (Benjamin et al. 1995). Despite the fact that a large proportion of AF cases are asymptomatic and intermittent, these episodes increase the risk of ischemic stroke (Healey et al. 2012). Numerous studies have shown an association between air pollution and cardiovascular morbidity and mortality (Liao et al. 2011; Lepeule et al. 2012; Chen et al. 2013; Madrigano et al. 2013). Studies focusing on AF as the main outcome of interest usually identify AF by either hospitalization diagnosis or implantable cardioverter defibrillator (ICD) recorded epi- sodes. Although the validity of hospitalization-based defini- tion of AF has been demonstrated (Smith et al. 2010), this approach can result in misclassification of AF as a primary admission diagnosis rather than comorbidity (Powell et al. Maayan Yitshak Sade and Alina Vodonos contributed equally to this manuscript. M. Yitshak Sade (*) : A. Vodonos : M. Friger : L. Novack Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel e-mail: maayan845@gmail.com M. Yitshak Sade : A. Vodonos : V. Novack Clinical Research Center, Soroka University Medical Center, Beer Sheva, Israel G. Amit Department of Cardiology, Soroka University Medical Center, Beer Sheva, Israel I. Katra Department of Geography and Environmental Development, Faculty of Humanities and Social Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel J. Schwartz Environmental Epidemiology Program, Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA Air Qual Atmos Health DOI 10.1007/s11869-014-0295-2