title: The World Trade Center attack: increased frequency of defibrillator shocks for ventricular arrhythmias in patients living remotely from New York City.
abstract: OBJECTIVE
  The goal of this study was to determine whether the World Trade Center (WTC) attack on September 11, 2001, had an effect on the occurrence of ventricular arrhythmias among patients with implantable cardioverter-defibrillators (ICDs) living in Florida.
  
  
  BACKGROUND
  Increased frequencies of ICD therapies for ventricular arrhythmias were reported among patients in New York City after the attack on the WTC. Whether this effect also occurred in patients living geographically distant from New York is unknown.
  
  
  METHODS
  This was an observational study consisting of 132 ICD patients who presented to the University of Florida and the Veterans Affairs Medical Center in Gainesville, Florida, for routine ICD follow-up around the time of the WTC attack. The occurrence of ventricular tachyarrhythmias triggering ICD therapy in the 30 days before and after September 11 constituted the primary end point.
  
  
  RESULTS
  In the 30 days following the WTC attack, a total of 14 patients (11%) had ventricular tachyarrhythmias, compared with 5 (3.8%) in the preceding 30 days (p = 0.0389, 95% confidence interval [CI] 0.4 to 13.3). This represents a 2.8-fold risk increase. Patients with ventricular arrhythmias both before and after September 11 demonstrated a rate increase of 2.38 events per patient (p = 0.0231, 95% CI 1.03 to 13.97).
  
  
  CONCLUSIONS
  The frequency of ventricular arrhythmias requiring ICD treatment increased by 68% among patients in Florida around the WTC attack. These findings suggest that stress-related arrhythmogenesis due to the WTC tragedy was not restricted to the geographic location of the attack. A major national tragedy may cause widespread increased risk of potentially life-threatening ventricular arrhythmias.
authors.affiliation: Division of Cardiovascular Medicine and Malcolm Randall Veteran Affairs Medical Center, University of Florida, Gainesville, Florida 32610, USA. omergosh@ufl.edu
authors.forename: Omer L
authors.initials: OL
authors.lastname: Shedd
authors.forename: Samuel F
authors.initials: SF
authors.lastname: Sears
authors.forename: Jane L
authors.initials: JL
authors.lastname: Harvill
authors.forename: Aysha
authors.initials: A
authors.lastname: Arshad
authors.forename: Jamie B
authors.initials: JB
authors.lastname: Conti
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Steinberg
authors.forename: Anne B
authors.initials: AB
authors.lastname: Curtis
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001145:Arrhythmias, Cardiac / Q000453:epidemiology / Q000209:etiology; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D017147:Defibrillators, Implantable; D005260:Female; D005431:Florida / Q000453:epidemiology; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D008016:Life Change Events; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology*; D012307:Risk Factors; D013315:Stress, Psychological / Q000150:complications / Q000453:epidemiology; D017180:Tachycardia, Ventricular / Q000453:epidemiology* / Q000209:etiology*; D023481:Terrorism; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors