Life-threatening cardiac arrhythmia and sudden death during electronic gaming: An international case series and systematic review.

BACKGROUND: Electronic gaming has recently been reported as a precipitant of life-threatening cardiac arrhythmia in susceptible individuals. OBJECTIVE: 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. METHODS: 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. CONCLUSION: 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.

Potential Role of Life Stress in Unexplained Sudden Cardiac Arrest.

BACKGROUND: The etiology of sudden cardiac arrest (SCA) in individuals without known cardiovascular heart disease remains elusive in nearly half of all patients after systematic testing. We investigated the relationship between stressful life events and SCA risk in cases of explained and unexplained SCA (USCA) events. METHODS: Individuals who previously experienced SCA were enrolled prospectively and divided into a USCA or explained SCA (ESCA) subgroup dependent on whether a diagnosis was ascribed after SCA. Participants completed either the 1997 Recent Life Changes Questionnaire, Student Stress Scale, or Social Re-adjustment Rating Scale for Non-Adults recalling events during the year preceding their SCA, depending on age at SCA presentation; all measure stress in life change units (LCUs). SCA group scores were compared with an age- and sex-matched control group. RESULTS: We compared 36 SCA group participants (22 USCA, 14 ESCA, age 47 ± 15 years, age at SCA 40 ± 14 years, 50% male) with 36 control participants (age 47 ± 15 years, 50% male). There was no significant difference in LCU score between the control group and the SCA group (248 ± 181 LCU vs 252 ± 227 LCU; P > .05). The ESCA subgroup had significantly lower mean LCU scores than the USCA subgroup (163 ± 183 LCU vs 308 ± 237 LCU; P = .030). CONCLUSIONS: Stressful life events, especially those producing chronic stress, might predispose otherwise healthy individuals to lethal arrhythmias. Further investigation into the role of stress in SCA precipitation is warranted.

CONTEXTE: La cause de l'arrêt cardiaque subit (ACS) chez les personnes n'ayant pas de maladie cardiovasculaire connue demeure nébuleuse dans près de la moitié des cas, même après des examens systématiques. Nous avons étudié la relation entre les événements stressants de la vie et le risque d'ACS chez des patients présentant un ACS expliqué (ACSe) ou inexpliqué (ACSi). MÉTHODOLOGIE: Des sujets ayant déjà subi un ACS ont été recrutés de manière prospective et répartis en deux sous-groupes (ACSe et ACSi), selon qu'un diagnostic a pu ou non être posé après l'ACS. On a demandé aux participants de répondre au questionnaire RLCQ (Recent Life Changes Questionnaire, questionnaire sur les changements de vie récents, version de 1997), au questionnaire SSS (Student Stress Scale, échelle d'évaluation du stress vécu par les étudiants) ou au questionnaire SRRS (Social Readjustment Rating Scale, échelle d'évaluation du réajustement social) pour les non-adultes en repensant aux événements survenus dans l'année précédant l'ACS, selon leur âge au moment de l'ACS; tous ces questionnaires mesurent le stress en unités de changement de vie (UCV). Les scores des patients ayant subi un ACS ont été comparés à ceux de sujets témoins appariés selon l'âge et le sexe. RÉSULTATS: Nous avons comparé 36 sujets ayant subi un ACS (22 ACSi et 14 ACSe; âge : 47 ± 15 ans; âge au moment de l'ACS : 40 ± 14 ans; proportion d'hommes : 50 %) à 36 sujets témoins (âge : 47 ± 15 ans; proportion d'hommes : 50 %). Il n'y avait pas de différence significative quant au score UCV entre le groupe témoin et le groupe ACS (248 ± 181 UCV vs 252 ± 227 UCV; p > 0,05). Les sujets du sous-groupe ACSe avaient un score UCV moyen significativement plus faible que ceux du sous-groupe ACSi (163 ± 183 UCV vs 308 ± 237 UCV; p = 0,030). CONCLUSIONS: Les événements stressants, plus particulièrement ceux qui entraînent un stress chronique, peuvent prédisposer des personnes autrement en bonne santé aux arythmies mortelles. Une étude plus poussée du rôle du stress dans la survenue précipitée d'un ACS s'impose.

Paediatric supraventricular tachycardia patients potentially more at risk of developing psychological difficulties compared to healthy peers.

AIM: Assess executive and socio-emotional/behavioural functioning in paediatric supraventricular tachycardia (SVT) patients. METHODS: SVT patients aged 7-17 who had not undergone catheter ablation were included. Parents completed the Child Behaviour Checklist (CBCL/6-18) and the Behavior Rating Inventory of Executive Functioning (BRIEF). Participants age 11-17 years completed the Youth Self-Report (YSR/11-18) and the BRIEF Self-Report (BRIEF-SR). One-sample z test was used to compare questionnaire results to the average t-score range (M = 50, SD = 10). RESULTS: Thirty (18 female) children/adolescents participated (M = 12.6 years old, SD = 3.2 years) with a mean SVT onset age of 7 years (SD = 4.3 years). BRIEF and BRIEF-SR results suggested no difference in executive functioning from average. Mean t-scores of CBCL/6-18 and YSR/11-18 subscales Anxious/Depressed, Withdrawn/Depressed, Somatic Complaints, Thought Problems, Diagnostic and Statistical Manual of Mental Disorders (DSM) Affective Problems, DSM Anxiety Problems and DSM Somatic Problems were significantly elevated compared to average. YSR/11-18 subscales Social Problems, Attention Problems, Internalizing Problems, DSM ADHD Problems and DSM Oppositional Defiant Problems had elevated mean t-scores compared to average. Effect sizes were small to medium (0.2 ≤ d ≤ 0.8). CONCLUSION: Paediatric patients with SVT potentially have a greater risk of developing behaviour, especially internalizing, problems compared to similarly aged children/adolescents without SVT.