Increased incidence of life-threatening ventricular arrhythmias in implantable defibrillator patients after the World Trade Center attack.
OBJECTIVE
This study was designed to evaluate whether the destruction of the World Trade Center (WTC) on September 11, 2001 (9/11), led to an increased frequency of ventricular arrhythmias among patients fitted with an implantable cardioverter-defibrillator (ICD).


BACKGROUND
The WTC attack induced psychological distress. Because ICDs store all serious arrhythmias for months, the attack provided a unique opportunity to compare pre- and post-9/11 frequencies of potentially lethal arrhythmias among ICD patients.


METHODS
Two hundred consecutive ICD patients who presented for regularly scheduled follow-up to six affiliated clinics were recruited into this observational study. The electrograms stored in the ICDs for the three months before 9/11 and 13 months thereafter were scrutinized in a blinded manner (relative to date) for all ventricular tachyarrhythmias (tachycardia or fibrillation) triggering ICD therapy.


RESULTS
The frequency of tachyarrhythmias increased significantly for the 30 days post-9/11 (p = 0.004) relative to all other months between May 2001 and October 2002. In the 30 days post-9/11, 16 patients (8%) demonstrated tachyarrhythmias, compared with only seven (3.5%) in the preceding 30 days, representing a 2.3-fold increase in risk (95% confidence interval 1.1 to 4.9; p = 0.03). The first arrhythmic event did not occur for three days following 9/11, with events accumulating in a progressive non-clustered pattern.


CONCLUSIONS
Ventricular arrhythmias increased by more than twofold among ICD patients following the WTC attack. The delay in onset and the non-clustered pattern of these events differ sharply from effects following other disasters, suggesting that subacute stress may have served to promote this arrhythmogenesis.
Steinberg
Jonathan S
JS
Division of Cardiology, St. Luke's-Roosevelt Hospital Center and Columbia University College of Physicians and Surgeons, New York, New York 10025, USA. jss7@columbia.edu
Arshad
Aysha
A
Kowalski
Marcin
M
Kukar
Atul
A
Suma
Valentin
V
Vloka
Margot
M
Ehlert
Frederick
F
Herweg
Bengt
B
Donnelly
Jacqueline
J
Philip
Julie
J
Reed
George
G
Rozanski
Alan
A
D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000453:epidemiology / Q000209:etiology; D003327:Coronary Disease / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D017147:Defibrillators, Implantable; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008016:Life Change Events; D008297:Male; D008875:Middle Aged; D009515:New Jersey / Q000453:epidemiology; D009518:New York / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology*; D011237:Predictive Value of Tests; D012307:Risk Factors; D013315:Stress, Psychological / Q000150:complications / Q000453:epidemiology; D013318:Stroke Volume / Q000502:physiology; D017180:Tachycardia, Ventricular / Q000453:epidemiology* / Q000209:etiology*; D023481:Terrorism; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000453:epidemiology* / Q000209:etiology*