title: Increased incidence of life-threatening ventricular arrhythmias in implantable defibrillator patients after the World Trade Center attack.
abstract: 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.
authors.affiliation: 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
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Steinberg
authors.forename: Aysha
authors.initials: A
authors.lastname: Arshad
authors.forename: Marcin
authors.initials: M
authors.lastname: Kowalski
authors.forename: Atul
authors.initials: A
authors.lastname: Kukar
authors.forename: Valentin
authors.initials: V
authors.lastname: Suma
authors.forename: Margot
authors.initials: M
authors.lastname: Vloka
authors.forename: Frederick
authors.initials: F
authors.lastname: Ehlert
authors.forename: Bengt
authors.initials: B
authors.lastname: Herweg
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Donnelly
authors.forename: Julie
authors.initials: J
authors.lastname: Philip
authors.forename: George
authors.initials: G
authors.lastname: Reed
authors.forename: Alan
authors.initials: A
authors.lastname: Rozanski
mesh_terms: 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*