Playing video games can cause potentially fatal cardiac arrhythmias in susceptible children, including those who are not known to be at risk, and war games are a powerful trigger. This was revealed by an international case series and systematic review.
Nineteen patients had suspected or diagnosed ventricular arrhythmias while playing video games, six suffered cardiac arrest, and four died suddenly.
“Now that this new phenomenon has been identified, we need to ensure that children and teenagers with underlying medical conditions are safe in all activities.” Claire M. Rowley, MBBS, Ph.D., Christian Turner, MBBS Children’s Hospitals Network, Sydney, Australia said theheart.org| Medscape Cardiology.
“Children or teenagers with new syncope, fainting, collapse, or seizures should see their local or primary care physician. [who] We will then decide if further testing is necessary,” they said.
research is publish online in my diary today heart rhythm.
potentially fatal
Lawley and Turner explain: “After contacting some of our close colleagues in our own region, we discovered that this phenomenon was not confined to our patients alone. I called for similar experiences.”
In this study, electronic games are defined as “games that use electronic devices to create systems with which players can interact”, including handheld electronic games, console-based electronic games, computer-based games, and stand-alone systems such as was defined as “playing As an electromechanical arcade game.
The team identified 22 patients (18 in an international case series and 4 in a systematic review) with suspected or proven experience with ventricular arrhythmias while playing video games. The patients (19 males and 3 females) ranged from he was 7 years old to he was 16 years old.
Nineteen of the 22 patients had a diagnosis of proarrhythmia, and 7 of the 19 patients (32%) had the diagnosis established prior to the game event. Of the seven individuals whose diagnosis was established prior to the game event, six were prescribed beta-blockers, two had on-the-spot ICDs, and one had an insertable heart monitor.12 Diagnosis was made after a gaming event in one (55%) of patients.
Ten of the 19 patients diagnosed as proarrhythmogenic had a catecholaminergic polymorphism. ventricular tachycardia (CPVT), 4 had long QT syndrome, 2 had congenital heart surgery, and 2 were idiopathic. ventricular fibrillationand one later had coronary artery ischemia Kawasaki disease.
The diagnosis is unknown in 3 patients, including 2 who died.
Genetic test results were available for 17 (77%) patients, and relevant genetic mutations were identified in 14 cases.
Management varied according to the severity of the episode presented, local institutional practices, and patient and family preferences. Of note, five of the 18 survivors subsequently developed arrhythmias while playing electronic games, four of whom were on antiarrhythmic drugs at the time.
Video game details were known in 13 patients (59%). 8 out of 13 (62%) were playing war games.
The authors suggest that adrenergic stimulation plays a role in the pathophysiology of these arrhythmic events.
They note that the “opt-in nature” of the study may have led to an “underestimation of the number of cases” and did not address the event in older videogamers. No information was available on potential confounders, such as sleep habits and stimulant use.
Nevertheless, they warn that electronic gaming may be encouraged under the false premise that it may be a safer alternative to high-risk sports.
“Previously, heart rhythm experts around the world needed to educate children with specific heart rhythm conditions and their families about safe sporting activities,” Rowley and Turner said. We also need to educate them about safe electronic gaming activities.”
Promote greater awareness
Elizabeth DeWitt, M.D., medical director of the Surgical Electrophysiology Program at Boston Children’s Hospital and assistant professor of pediatrics at Harvard Medical School, commented on the study: theheart.org/Medscape Cardiology“I was caring for a patient who had a cardiac arrest and emotional agitation while playing an interactive movie/video game and was eventually diagnosed with CPVT. was the first cardiac symptom.
“As the authors point out, this is not what I would normally specifically advise patients with known hereditary arrhythmia syndromes to be cautious about, but the emphasis on general exercise and emotional arousal risks.” “It’s important to highlight this topic and raise more awareness,” she said.
“Cause unknown syncope or palpitations during electronic games in previously healthy children or such children congenital heart disease detailed medical history, family history, electro-cardiogramsaid DeWitt, who was not involved in the study.
A multicenter registry will track such cases and collect more from around the world in the future to determine whether additional recommendations or approaches to management beyond those described are important. to confirm,” she suggests.
Rethinking “Effort”
While not common, the phenomenon is becoming more common, says Jonathan Skinner, MBChB, MD, also a research collaborator at the Sydney Children’s Hospital Network.
“Having cared for children with arrhythmias for over 25 years, I was amazed to learn how prevalent this new condition is and how many children are dying from it.” is keen to publicize this phenomenon so that our colleagues around the world can recognize it and protect these children and their families.”
write in Related editorialsJonathan Lust, M.D., William White, M.D., and Daniel Sohinke, M.D., of Augusta University in Georgia, said, “Today, ‘exercise’ should be understood to encompass activities outside of traditional athletics. Appropriate Counseling Instructions regarding the risks of intense video game play should be directed to children diagnosed with proarrhythmic heart disease and children with a history of unexplained kinetic syncope.”
“In addition, future screening programs aimed at identifying athletes at risk for malignant arrhythmias should include athletes considering participation in eSports.”
Funding sources were not disclosed. The study authors and editors did not report any relevant financial relationships.
heart rhythm. Published online on October 11, 2022. Overview, editorial
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