Electronic gaming can precipitate lethal cardiac arrhythmias in susceptible children: study

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. Electronic gaming has recently been reported as a precipitant of life-threatening cardiac arrhythmia in susceptible individuals.

The purpose of this study was to describe the population at risk, the nature of cardiac events, and the type of game linked to cardiac arrhythmia associated with electronic gaming.

A multisite international case series of suspected or proven cardiac arrhythmia during electronic gaming in children and a systematic review of the literature were performed.

Results:

• Twenty-two patients (18 in the case series and 4 via systematic review; aged 7–16 years; 19 males [86%]) were identified as having experienced suspected or proven ventricular arrhythmia during electronic gaming; 6 (27%) had experienced cardiac arrest, and 4 (18%) died suddenly.
• A proarrhythmic cardiac diagnosis was known in 7 (31%) patients before their gaming event and was established afterward in 12 (54%).
• Ten patients (45%) had catecholaminergic polymorphic ventricular tachycardia, 4 (18%) had long QT syndrome, 2 (9%) were post–congenital cardiac surgery, 2 (9%) had "idiopathic" ventricular fibrillation, and 1 (after Kawasaki disease) had coronary ischemia.
• In 3 patients (14%), including 2 who died, the diagnosis remains unknown.
• In 13 (59%) patients for whom the electronic game details were known, 8 (62%) were war games.

Thus, electronic gaming can precipitate lethal cardiac arrhythmias in susceptible children. The incidence appears to be low, but syncope in this setting should be investigated thoroughly. In children with proarrhythmic cardiac conditions, electronic war games in particular are a potent arrhythmic trigger.

Reference:

Claire M. Lawley, Matthew Tester, Shubhayan Sanatani, 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 System. Published: October 10, 2022DOI: https://doi.org/10.1016/j.hrthm.2022.08.003

Keywords:

Arrhythmia, Syncope, Sudden cardiac death, electronic gaming, Adolescent, Heart Rhythm System, Claire M. Lawley, Matthew Tester, Shubhayan Sanatani, Maully J. Shah, Jonathan R. Skinner, Christian Turner