Associations between exposure to air pollutants and QT interval change: A comprehensive systematic review

Air pollutants can affect the human cardiovascular system, but their impact on cardiac conduction remains unclear. We have undertaken a systematic review to compile the existing evidence. We conducted a comprehensive search across the MEDLINE/PubMed, Embase, Scopus, Cochrane Library, and Web of Science databases to identify all pertinent studies published before January 2025, that quantitatively assessed the effect of air pollutants including particulate matter with diameter ≤1, 2.5 or 10 μm (PM₁, PM_2.5 or PM₁₀), ozone (O₃), nitrogen dioxide (NO₂), sulfur dioxide (SO₂), carbon monoxide (CO), elemental carbon (EC), organic carbon (OC), and black carbon (BC) on QT interval. A total of 24 articles, involving 174,526 participants, met the inclusion criteria. The majority of studies demonstrated that exposure to various air pollutants was associated with an increased risk of QT prolongation. In contrast, some studies reported a reverse association for pollutants such as PM_2.5, PM₁₀, EC, and NO₂. Existing evidence highlights the relationship between exposure to air pollutants and adverse effects on the QT duration. Individuals at risk of cardiac diseases should take measures to reduce their exposure to air pollutants.