Alahmad Barrak, Oyekunle Taofik, Strohmeyer Claire, Rudke Anderson P, Koutrakis Petros, Mela Theofanie
Environmental Health Department Harvard T.H. School of Public Health Boston MA.
Medtronic, Clinical & Regulatory Solutions (MCRS) Medtronic Mounds View MN.
J Am Heart Assoc. 2025 Jun 17;14(12):e040352. doi: 10.1161/JAHA.124.040352. Epub 2025 Jun 5.
Arrhythmia, particularly atrial fibrillation, is on the rise globally. While increased surveillance, aging populations, and other risk factors partially explain this rise, emerging risks such as extreme heat from climate change are underexplored.
We used Product Surveillance Registry by Medtronic (2016-2023) in the United States to examine patients with implantable cardioverter-defibrillator or cardiac resynchronization therapy defibrillator devices. We identified first arrhythmic episodes (atrial tachycardia/fibrillation [AT/AF] or ventricular tachycardia/fibrillation) recorded by devices. Events were matched to ambient temperatures from local weather stations. We used a case-crossover design where each arrhythmia event hour was matched with multiple control hours from the same patient, within the same day of week, month, and year. Conditional logistic models were then pooled across all climate zones in the United States to obtain nonlinear dose-response between temperature and arrhythmia.
Our analysis included 3079 individuals across 103 cities. Fewer AT/AF and ventricular tachycardia/fibrillation events occurred during early morning hours (1 am-8 am) compared with daytime hours (9 am-4 pm) ( <0.001). AT/AF episodes were also fewer on weekends compared with weekdays ( <0.001). We found a significant dose-response relationship between high outdoor temperatures and AT/AF events. Relative to an optimal temperature (19 °C), odds ratios for AT/AF events increased substantially at temperatures of 39 °C (odds ratio, 2.41 [95% CI, 1.37-4.25]), 40 °C (odds ratio, 2.60 [95% CI, 1.38-4.89]), and 41 °C (odds ratio, 2.81 [95% CI, 1.40-5.63]). No significant association between temperature and ventricular tachycardia/ ventricular fibrillation was observed. Lagged temperature exposures did not change the results.
Extreme hot outdoor temperatures were significantly associated with higher odds of AF episodes.
心律失常，尤其是心房颤动，在全球范围内呈上升趋势。虽然监测增加、人口老龄化和其他风险因素部分解释了这种上升趋势，但气候变化带来的极端高温等新出现的风险尚未得到充分研究。
我们利用美敦力公司的产品监测登记系统（2016 - 2023年）在美国对植入式心脏复律除颤器或心脏再同步治疗除颤器设备的患者进行了研究。我们确定了设备记录的首次心律失常发作（房性心动过速/心房颤动[AT/AF]或室性心动过速/心室颤动）。事件与当地气象站的环境温度进行匹配。我们采用病例交叉设计，将每个心律失常事件发生的小时数与同一患者在同一周、月和年的同一天内的多个对照小时数进行匹配。然后，在美国所有气候区汇总条件逻辑模型，以获得温度与心律失常之间的非线性剂量反应关系。
我们的分析纳入了103个城市的3079名个体。与白天时间（上午9点至下午4点）相比，凌晨时段（凌晨1点至上午8点）发生的AT/AF和室性心动过速/心室颤动事件较少（<0.001）。与工作日相比，周末的AT/AF发作也较少（<0.001）。我们发现室外高温与AT/AF事件之间存在显著的剂量反应关系。相对于最佳温度（19°C），在39°C（优势比，2.41[95%CI，1.37 - 4.25]）、40°C（优势比，2.60[95%CI，1.38 - 4.89]）和41°C（优势比，2.81[95%CI，1.40 - 5.63]）时，AT/AF事件的优势比大幅增加。未观察到温度与室性心动过速/心室颤动之间存在显著关联。滞后的温度暴露并未改变结果。
室外极端高温与房颤发作几率较高显著相关。
