CORRESPONDENCE: LETTER TO THE EDITOR
Reply
Jonathan S. Steinberg, MD, FACC*,
Aysha Arshad, MBBS,
Alan Rozanski, MD, FACC,
Omer L. Shedd, MD and
Anne B. Curtis, MD, FACC
* Division of Cardiology,St. Luke’s-Roosevelt Hospital Center,1111 Amsterdam Avenue,New York, NY 10025 (Email: jss7{at}columbia.edu).
We appreciate the comments of Dr. Fauchier and colleagues regarding our recent reports describing an increase in the incidence of life-threatening ventricular arrhythmias in both New York City (1) and Florida (2) in the aftermath of the World Trade Center (WTC) attack.
A concern was raised that we did not compare the event rate of 2001 with a control period. In fact, we did compare the 30-day period following September 2001 with 13 monthly periods afterward (including September 2002) and found the index month to have a statistically higher arrhythmia event rate, with an odds ratio of 2.5 (p = 0.004) than all other monthly intervals (1). Thus, there appeared to be a specific aberration temporally linked to the period following the WTC attack, which was not attributable to seasonal or monthly variation. We also noted that the study of cardiovascular mortality in New York City (3) did not confirm a higher death rate, but this form of analysis, using death certificates, is fraught with inaccuracies in assessment of cause of death that may make it insensitive for evaluating specific arrhythmic events.
Fauchier et al. state that if the events had concentrated in the morning hours after the attack on September 11, this would lend credence to our conclusions. However, as described (1), the event rate did not increase on September 11, but did increase three days later, and remained elevated for one month. In respect to the diurnal variation of events, we surprisingly found a shift in the preponderance of events to the evening instead of the morning (J.S. Steinberg, unpublished observations, 2001), supporting speculation that stress was heightened by exposure to the graphic scenes replayed by the media (1).
 |
References
|
|---|
1. Steinberg JS, Arshad A, Kowalski M, et al. Increased incidence of life-threatening ventricular arrhythmias in implantable defibrillator patients after the World Trade Center attack J Am Coll Cardiol 2004;44:1261-1264.[Abstract/Free Full Text]
2. Shedd OL, Sears Jr SF, Harvill JL, et al. The World Trade Center attackincreased frequency of defibrillator shocks for ventricular arrhythmias in patients living remotely from New York City. J Am Coll Cardiol 2004;44:1265-1267.[Abstract/Free Full Text]
3. Chi JS, Poole WK, Kandefer SC, Kloner RA. Cardiovascular mortality in New York City after September 11, 2001 Am J Cardiol 2003;92:857-861.[CrossRef][Web of Science][Medline]
Related Article
-
The Optimal Low-Density Lipoprotein Is 50 to 70 mg/dl
- Robert Clendenning
J. Am. Coll. Cardiol. 2005 45: 1732.
[Full Text]
[PDF]
|
Top
References