Impact of the 2023 Turkiye Earthquake on the Incidence of Hospitalized Acute Atrial Fibrillation and Ventricular Tachycardia

Abstract

Background: Natural disasters impose substantial psychological and physiological stress, which may serve as powerful triggers for cardiac arrhythmias. Previous earthquakes worldwide have been linked to a rise in cardiovascular morbidity and mortality, yet data from Türkiye are limited. This study aimed to evaluate the impact of the devastating 2023 Türkiye Earthquake on the incidence of hospitalized acute atrial fibrillation (AF) and ventricular tachycardia (VT). Methods: We conducted a single-center retrospective analysis at a tertiary referral hospital that served as a major regional care center following the earthquake. Hospital admissions for acute AF and VT were compared across two consecutive two-month periods: pre-earthquake (December 6, 2022–February 6, 2023) and post-earthquake (February 6–April 6, 2023). Adult patients aged ≥18 years with electrocardiographically confirmed AF or VT requiring hospitalization were included. Results: A significant increase was observed in AF hospitalizations post-earthquake (11 vs. 24 cases; 0.35% vs. 0.75%; p=0.029), while VT admissions showed a non-significant rise (11 vs. 14 cases; p=0.56). Demographics and comorbidities were comparable between groups. Post-earthquake AF patients had shorter hospital stays. In both cohorts, hospitalizations were shorter following the earthquake. Conclusion: Hospitalizations for acute AF significantly increased after the 2023 Turkiye Earthquake, likely due to stress-related arrhythmogenesis. Although VT admissions also rose, the difference was not statistically significant.

Keywords

• Earthquake
• atrial fibrillation
• ventricular tachycardia
• arrhythmia

2023 Türkiye Depreminin Hastaneye Yatırılan Akut Atriyal Fibrilasyon ve Ventriküler Taşikardi İnsidansı Üzerindeki Etkisi

Öz

Giriş:% Doğal afetler, kardiyak aritmiler için güçlü tetikleyiciler olarak işlev görebilecek önemli psikolojik ve fizyolojik stres yaratır. Dünya çapında daha önce meydana gelen depremler, kardiyovasküler morbidite ve mortalitede artışla ilişkilendirilmiştir, ancak Türkiye'den elde edilen veriler sınırlıdır. Bu çalışma, yıkıcı 2023 Türkiye Depremi'nin hastaneye yatırılan akut atriyal fibrilasyon (AF) ve ventriküler taşikardi (VT) insidansı üzerindeki etkisini değerlendirmeyi amaçlamaktadır. Gereç ve Yöntemler: Deprem sonrasında büyük bir bölgesel bakım merkezi olarak hizmet veren üçüncü basamak bir sevk hastanesinde tek merkezli retrospektif bir analiz gerçekleştirdik. Akut AF ve VT için hastaneye yatışlar, deprem öncesi (6 Aralık 2022-6 Şubat 2023) ve deprem sonrası (6 Şubat-6 Nisan 2023) olmak üzere iki ardışık iki aylık dönemde karşılaştırıldı. Elektrokardiyografi ile doğrulanmış AF veya VT tanısı almış ve hastaneye yatış gerektiren 18 yaş ve üzeri yetişkin hastalar çalışmaya dahil edildi. Sonuç: Deprem sonrası AF nedeniyle hastaneye yatışlarda anlamlı bir artış gözlenirken (11'e karşı 24 vaka; %0,35'e karşı %0,75; p=0,029), VT nedeniyle hastaneye yatışlarda anlamlı olmayan bir artış görüldü (11'e karşı 14 vaka; p=0,56). Demografik özellikler ve eşlik eden hastalıklar gruplar arasında benzerdi. Deprem sonrası AF hastalarının hastanede kalış süreleri daha kısaydı. Her iki kohortta da deprem sonrası hastaneye yatış süreleri daha kısaydı. Tartışma: Akut AF nedeniyle hastaneye yatışlar, muhtemelen strese bağlı aritmogeneze bağlı olarak 2023 Türkiye Depremi'nden sonra önemli ölçüde arttı. VT nedeniyle hastaneye yatışlar da artmış olsa da, aradaki fark istatistiksel olarak anlamlı değildi.

Anahtar Kelimeler

• Deprem
• atriyal fibrilasyon
• ventriküler taşikardi
• aritmi

Kaynakça

1. 1. Dakhil ZA, Farhan HA, Faraz F, Skuk MR, Al-Jorani MS, Rehman MEU, et al. Impact of earthquake on cardiovascular health: what should cardiovascular healthcare providers anticipate after the devastating earthquakes in Turkey and Syria? Current Problems in Cardiology. 2023;48(9):101800. [Crossref]
2. 2. Kloner RA. Lessons learned about stress and the heart after major earthquakes. American Heart Journal. 2019;215:20-26. [Crossref]
3. 3. Babaie J, Naghipour B, Faridaalaee G. Cardiovascular diseases in natural disasters; a systematic review. Archives of Academic Emergency Medicine. 2021;9(1):e36. [Crossref]
4. 4. Ranjbar F, Akbarzadeh F, Kazemi B, Ranjbar A, Namin SS, Sadeghi-Bazargani H. Increased likelihood of arrhythmic events associated with increased anxiety in patients with implanted cardiac defibrillators after the Ahar-Varzegan Earthquake in East Azarbaijan, 2012. Bulletin of Emergency & Trauma. 2016;4(4):202. [Crossref]
5. 5. Thorpe H. Natural disaster arrhythmia and action sports: The case of the Christchurch earthquake. International Review for the Sociology of Sport. 2015;50(3):301-325. [Crossref]
6. 6. Chan C, Daly M, Melton I, Crozier I. Two major earthquakes in Christchurch were not associated with increased ventricular arrhythmias: Analysis of implanted defibrillator diagnostics. PLoS ONE. 2019;14(5):e0216521. [Crossref]
7. 7. Nakano M, Kondo M, Wakayama Y, Kawana A, Hasebe Y, Shafee MA, et al. Increased incidence of tachyarrhythmias and heart failure hospitalization in patients with implanted cardiac devices after the great East Japan earthquake disaster. Circulation Journal. 2012;76(5):1283-1285. [Crossref]
8. 8. Suzuki H, Ohira T, Takeishi Y, Hosoya M, Yasumura S, Satoh H, et al. Increased prevalence of atrial fibrillation after the Great East Japan Earthquake: results from the Fukushima Health Management Survey. International Journal of Cardiology. 2015;198:102-105. [Crossref]

9. 9. Leor J, Poole WK, Kloner RA. Sudden cardiac death triggered by an earthquake. New England Journal of Medicine. 1996;334(7):413-419. [Crossref]
10. 10. Akkuş O, Yasdıbaş R, Demirkıran RF, Elitaş V, Bekler Ö, Şen F, et al. Changes in acute coronary syndrome clinic after the devastating earthquake in Türkiye. Anatolian Journal of Cardiology. 2024;28(9):446. [Crossref]
11. 11. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. European Heart Journal Cardiovascular Imaging. 2015;16(3):233-271. [Crossref]
12. 12. Hahn RT, Saric M, Faletra FF, Garg R, Gillam LD, Horton K, et al. Recommended standards for the performance of transesophageal echocardiographic screening for structural heart intervention: from the American Society of Echocardiography. Journal of the American Society of Echocardiography. 2022;35(1):1-76. [Crossref]
13. 13. Aoki T, Fukumoto Y, Yasuda S, Sakata Y, Ito K, Takahashi J, et al. The great East Japan earthquake disaster and cardiovascular diseases. European Heart Journal. 2012;33(22):2796-2803. [Crossref]
14. 14. Tamaki K, Koshiyama M, Ohta M, Ohsawa M. Prevalence rates of atrial fibrillation tentatively increased during and after the Great East Japan earthquake. European Heart Journal. 2017;38(suppl_1):P4610. [Crossref]
15. 15. İlhan B, Berikol GB, Eroğlu O, Deniz T. Prevalence and associated risk factors of post-traumatic stress disorder among survivors of the 2023 Turkey earthquake. The American Journal of Emergency Medicine. 2023;72:39-43. [Crossref]
16. 16. Takahashi J, Satoh K, Fukuda K, Sugimura K, Matsumoto Y, Nakano M, et al. Overview of the 80th Annual Scientific Meeting of the Japanese Circulation Society–The Past, Present and Future of Cardiovascular Medicine in Japan–The 5th Anniversary of the Great East Japan Earthquake. Circulation Journal. 2016;80(8):1689-1694. [Crossref]
17. 17. Akkuş O, Yasdıbaş R, Binokay H. Impact of the earthquake disaster in Türkiye on the use of cardiac implantable electronic devices and clinical presentation of patients. Cukurova Medical Journal. 2024;49(4):985-995. [Crossref]
18. 18. Andrássy G, Szabo A, Ferencz G, Trummer Z, Simon E, Tahy Á. Mental stress may induce QT-interval prolongation and T-wave notching. Annals of Noninvasive Electrocardiology. 2007;12(3):251-259. [Crossref]
19. 19. Lecca LI, Portoghese I, Mucci N, Galletta M, Meloni F, Pilia I, et al. Association between work-related stress and QT prolongation in male workers. International Journal of Environmental Research and Public Health. 2019;16(23):4781. [Crossref]
20. 20. Tsuchida M, Kawashiri MA, Teramoto R, Takata M, Sakata K, Omi W, et al. Impact of severe earthquake on the occurrence of acute coronary syndrome and stroke in a rural area of Japan experience from the Noto Peninsula earthquake. Circulation Journal. 2009;73(7):1243-1247. [Crossref]
21. 21. Zhang XQ, Chen M, Yang Q, Di Yan S, Huang DJ. Effect of the Wenchuan earthquake in China on hemodynamically unstable ventricular tachyarrhythmia in hospitalized patients. The American Journal of Cardiology. 2009;103(7):994-997. [Crossref]
22. 22. Nakagawa I, Nakamura K, Oyama M, Yamazaki O, Ishigami K, Tsuchiya Y, et al. Long-term effects of the Niigata-Chuetsu earthquake in Japan on acute myocardial infarction mortality: an analysis of death certificate data. Heart. 2009;95(24). [Crossref]
23. 23. Kitamura T, Kiyohara K, Iwami T. The great east Japan earthquake and out-of-hospital cardiac arrest. New England Journal of Medicine. 2013;369(22):2165-2166. [Crossref]
24. 24. Dakhil ZA, Farhan HA, Faraz F, Skuk MR, Al-Jorani MS, Rehman MEU, et al. Impact of Earthquake on Cardiovascular Health: What Should Cardiovascular Healthcare Providers Anticipate After the Devastating Earthquakes in Turkey and Syria? Current Problems in Cardiology. 2023;48(9):101800. [Crossref]