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ELECTROPHYSIOLOGY

Increased incidence of life-threatening ventricular arrhythmias in implantable defibrillator patients after the World Trade Center attack

Jonathan S. Steinberg, MD, FACC^*,,*, Aysha Arshad, MBBS^*, Marcin Kowalski, MD^*, Atul Kukar, DO^*, Valentin Suma, MD^*, Margot Vloka, MD^*,, Frederick Ehlert, MD^*,, Bengt Herweg, MD^*,, Jacqueline Donnelly, BA^*, Julie Philip, PA-C^*, George Reed, PHD and Alan Rozanski, MD, FACC^*

^* Division of Cardiology, St. Luke's-Roosevelt Hospital Center and Columbia University College of Physicians and Surgeons, New York, New York, USA
Valley Hospital, Ridgewood, New Jersey, USA
Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA

Manuscript received September 19, 2003; revised manuscript received May 24, 2004, accepted June 7, 2004.

^* Reprint requests and correspondence: Dr. Jonathan S. Steinberg, Division of Cardiology, St. Luke's-Roosevelt Hospital Center, 1111 Amsterdam Avenue, New York, New York 10025 (Email: jss7{at}columbia.edu).

OBJECTIVES: 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.

Abbreviations and Acronyms   CI = confidence interval   ICD = implantable cardioverter-defibrillator   9/11 = September 11, 2001   RR = relative risk   VT = ventricular tachycardia   VF = ventricular fibrillation   WTC = World Trade Center

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