Effects of Extreme Humidity and Heat on Ventricular Arrhythmia Risk in Patients With Cardiac Devices

Background

Climate change is increasing the frequency of high heat and high humidity days. Whether these conditions can trigger ventricular arrhythmias [ventricular tachycardia/ventricular fibrillation, VT/VF] in susceptible persons is unknown.

Objectives

The purpose of this study was to determine the relationship between warm-season weather conditions and risk of VT/VF in individuals with pacemakers and defibrillators.

Methods

Baseline clinical and device data from 5,944 patients in North Carolina (2010-2021) were linked to daily weather data geocoded to individuals’ residential addresses. Associations between extreme humidity, temperature, and VT/VF overall and by patient, community, and built environment factors were estimated using a case time-series design with distributed lag nonlinear models, adjusting for temporal trends and individual factors.

Results

VT/VF events occurred on 4,486 of the 484,988 person-days. Extreme humidity (95th percentile: 90% relative humidity) increased odds of VT/VF in the 7 days following exposure (aOR 1.23 [95% CI: 1.00-1.51]). Humidity-associated VT/VF risk was highest among those who were male (aOR: 1.38 [95% CI: 1.08-1.76]), age 67 to 75 years (aOR: 1.65 [95% CI: 1.16-2.35]) with coronary artery disease (aOR: 1.79 [95% CI: 1.25-2.57]), heart failure (aOR: 1.72 [95% CI: 1.2-2.46]), diabetes (aOR: 3.01 [95% CI: 1.99-4.56]), hypertension (aOR: 2.06 [95% CI: 1.48-2.88]), and prior myocardial infarction (aOR: 1.75 [95% CI: 1.23-2.48]). Communities with high socioeconomic deprivation (aOR: 1.83 [95% CI: 1.28-2.62]), high income inequality (aOR: 1.56 [95% CI: 1.19-2.04]), and urban areas with less greenspace (aOR: 1.29 [95% CI: 0.93-1.78]) also had increased VT/VF risk. High temperatures were not associated with VT/VF.

Conclusions

In patients with preexisting cardiovascular disease, exposure to extreme humidity increased VT/VF risk, especially among vulnerable individuals, disadvantaged communities, and urban areas with less green space. These findings emphasize the need for policies that address environmental risks in susceptible individuals and communities.