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Diesel exhaust inhalation does not affect heart rhythm or heart rate variability
  1. Nicholas L Mills1,
  2. Alexander E Finlayson1,
  3. Manuel C Gonzalez2,
  4. Håkan Törnqvist3,4,
  5. Stefan Barath3,4,
  6. Elen Vink1,
  7. Colin Goudie1,
  8. Jeremy P Langrish1,
  9. Stefan Söderberg2,
  10. Nicholas A Boon1,
  11. Keith A A Fox1,
  12. Ken Donaldson5,
  13. Thomas Sandström3,4,
  14. Anders Blomberg3,4,
  15. David E Newby1
  1. 1Centre for Cardiovascular Science, Edinburgh University, Edinburgh, UK
  2. 2Department Public Health and Clinical Medicine, Medicine, Umeå University, Umeå, Sweden
  3. 3Department Public Health and Clinical Medicine, Respiratory Medicine, Umeå University, Umeå, Sweden
  4. 4Division of Respiratory Medicine and Allergy, Centre of Medicine, University Hospital, Umeå, Sweden
  5. 5ELEGI Colt Laboratory, Centre for Inflammation Research, Edinburgh University, Edinburgh, UK
  1. Correspondence to Dr Nicholas L Mills, Centre for Cardiovascular Science, The University of Edinburgh, Chancellor's Building, Edinburgh EH16 4SB, UK; nick.mills{at}


Objective Exposure to air pollution is associated with increases in cardiovascular morbidity and mortality. This study was undertaken to determine the effect of diesel exhaust inhalation on heart rhythm and heart rate variability in healthy volunteers and patients with coronary heart disease.

Design and setting Double-blind randomised crossover studies in a university teaching hospital.

Patients 32 healthy non-smoking volunteers and 20 patients with prior myocardial infarction.

Interventions All 52 subjects were exposed for 1 h to dilute diesel exhaust (particle concentration 300 μg/m3) or filtered air.

Main outcome measures Heart rhythm and heart rate variability were monitored during and for 24 h after the exposure using continuous ambulatory electrocardiography and assessed using standard time and frequency domain analysis.

Results No significant arrhythmias occurred during or following exposures. Patients with coronary heart disease had reduced autonomic function in comparison to healthy volunteers, with reduced standard deviations of the NN interval (SDNN, p<0.001) and triangular index (p<0.001). Diesel exhaust did not affect heart rate variability compared with filtered air (p>0.05 for all) in healthy volunteers (SDNN 101±6 vs 91±6, triangular index 20±1 vs 21±1) or patients with coronary heart disease (SDNN 47±5 vs 38±4, triangular index 8±1 vs 7±1).

Conclusions Brief exposure to dilute diesel exhaust does not alter heart rhythm or heart rate variability in healthy volunteers or well-treated patients with stable coronary heart disease. Autonomic dysfunction does not appear to be a dominant mechanism that can explain the observed excess in cardiovascular events following exposure to combustion-derived air pollution.

  • Air pollution
  • diesel exhaust
  • heart rate variability
  • autonomic function
  • autonomic regulation
  • heart rate variability
  • Holter ECG

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  • See Editorial, p 519

  • Linked articles 212183.

  • Funding NLM is supported by an Intermediate Clinical Research Fellowship from the British Heart Foundation (FS/10/024/28266); British Heart Foundation Programme Grant (RG/10/9/28286); National Health Service Research and Development Fund (SPG2005/27); Swedish Heart Lung Foundation; Swedish Research Council for Environment, Agricultural Sciences and Spatial Planning (FORMAS); Swedish National Air Pollution Programme; Swedish Emission Research Programme; Heart and Lung Associations in Sollefteå and Örnsköldsvik, and County Council of Västerbotten, Sweden.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the Regional Ethical Review Board, Sweden.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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