There have been recent case reports of children and adolescents experiencing suspected or proven cardiac arrhythmia during electronic gaming. Subsequent proarrhythmic cardiac diagnoses have had significant implications for these children and their families. The pathophysiological basis for this phenomenon is attributed to adrenergic stimulation related to the emotionally charged electronic gaming environment.
While competitive sport and certain high-risk activities are known to precipitate arrhythmic events in susceptible individuals, electronic gaming has not typically been included in the counseling provided to families with proarrhythmic diagnoses. Electronic gaming is a prevalent pastime in children and adolescents. In adolescents deemed to be at risk during competitive sporting activity, electronic gaming may be encouraged under the false premise that it may represent a safe alternative to higher-risk sports. The prevalence of electronic gaming–induced cardiac arrhythmia has not been investigated and would provide important background information for such counseling.
Cardiac Electrophysiology Society, and the Pediatric & Congenital Electrophysiology Society report a new study
The investigators performed a systematic review of literature and initiated a multisite international outreach effort to identify cases of children with sudden loss of consciousness while playing video games. Across the 22 cases they found, multiplayer war gaming was the most frequent trigger. Some children died following a cardiac arrest. Subsequent diagnoses of several heart rhythm conditions put the children at continuing risk. Catecholaminergic polymorphic ventricular tachycardia (CPVT) and congenital long QT syndrome (LQTS) types 1 and 2 were the most common underlying causes.
There was a high incidence of potentially relevant genetic variants (63%) among the patients, which has significant implications for their families. In some cases, the investigation of a child who lost consciousness during video gaming led to many family members being diagnosed with an important familial heart rhythm problem. “Families and healthcare teams should think about safety precautions around electronic gaming in children who have a condition where dangerous fast heart rhythms are a risk,” noted Dr. Lawley.
The investigators attributed adrenergic stimulation related to the emotionally charged electronic gaming environment as the pathophysiological basis for this phenomenon. Electronic gaming is not always the “safe alternative” to competitive sports it is often considered. At the time of the cardiac incidents, many of the patients were in excited states, having just won or lost games, or were engaging in conflict with companions.
“We already know that some children have heart conditions that can put them at risk when playing competitive sports, but we were shocked to discover that some patients were having life-threatening blackouts during video gaming,” added co-investigator Christian Turner, MBBS, The Heart Centre for Children, Sydney Children’s Hospitals Network, Sydney, Australia. “Video gaming was something I previously thought would be an alternative ‘safe activity.’ This is a really important discovery. We need to ensure everyone knows how important it is to get checked out when someone has had a blacking out episode in these circumstances.”
The study notes that while this phenomenon is not a common occurrence, it is becoming more prevalent. “Having looked after children with heart rhythm problems for more than 25 years, I was staggered to see how widespread this emerging presentation is, and to find that a number of children had even died from it. All of the collaborators are keen to publicize this phenomenon so our colleagues across the globe can recognize it and protect these children and their families,” noted co-investigator of the study, Jonathan Skinner, MBChB, MD, also from Sydney.
Claire M. Lawley, Matthew Tester, Shubhayan Sanatani, Terence Prendiville, Cheyenne M. Beach, Jeffrey M. Vinocur, Minoru Horie, Jae-Sun Uhm, Apichai Khongphatthanayothin, Mark D. Ayers, Luke Starling, Yoko Yoshida, Maully J. Shah, Jonathan R. Skinner, Christian Turner. Life-threatening cardiac arrhythmia and sudden death during electronic gaming: An international case series and systematic review. Heart Rhythm, 2022; DOI: 10.1016/j.hrthm.2022.08.003
Johnathan Rast, William White, Daniel Sohinki. Ventricular arrhythmias during electronic gaming: Sudden victory and sudden death. Heart Rhythm, 2022; DOI: 10.1016/j.hrthm.2022.08.028
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