Esports may raise risk for cardiac arrythmias, sudden death in susceptible children

Electronic gaming can precipitate lethal cardiac arrhythmias in children with proarrhythmic conditions, though worldwide incidence appears to be low overall, researchers reported.

In an international case series and systematic literature review, researchers also found that among children with proarrhythmic cardiac conditions, electronic war games in particular are a “potent arrhythmic trigger,” Claire M. Lawley, MBBS, PhD, FRACP, assistant professor of clinical and population perinatal health research at the University of Sydney, and colleagues wrote.

“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,” Lawley and colleagues wrote in Heart Rhythm. “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.”

Events uncommon but ‘clearly prevalent’

Lawley and colleagues analyzed data from 22 children aged 7 to 16 years with suspected or proven cardiac arrhythmia during electronic gaming, including four children identified during a systematic review of literature (14% girls). Within the cohort, 86% had experienced suspected or proven ventricular arrhythmia during electronic gaming; 27% experienced cardiac arrest and 18% died suddenly. A proarrhythmic cardiac diagnosis was known for 31% of patients before their gaming event and was established afterward in 54%.

Within the cohort, 45% had catecholaminergic polymorphic ventricular tachycardia, 18% had long QT syndrome, 9% had congenital cardiac surgery, 9% had idiopathic ventricular fibrillation and one child had coronary ischemia after Kawasaki disease. The diagnosis was unknown for three patients, including two who died.

Researchers had electronic game details for 59% of patients; 62% were playing war games at the time of their event.

“The stage of play at the time of the event was known in seven (32%) of patients, six of whom had just won or lost and one of these was jumping up and down in excitement,” the researchers wrote.

“Given the large number of centers approached for cases across the world, it is clear that this phenomenon is uncommon, but it is clearly prevalent internationally and may represent a meaningful issue in children with arrhythmic conditions,” the researchers wrote. “Electronic gaming can pose a significant arrhythmic risk; it can be lethal in children with predisposing (but often previously unrecognized) arrhythmic conditions.”

Rethinking ‘exertion’

In a related editorial, Johnathan Rast, BS, of the Medical College of Georgia at Augusta University, and colleagues noted that “exertion” should be understood to encompass activities outside of traditional competitive athletics.

“Appropriate counseling regarding the risks of intense video gameplay should be targeted toward children with a proarrhythmic cardiac diagnosis and any child with a history of exertional syncope of undetermined etiology,” Rast and colleagues wrote. “Furthermore, any future screening programs aimed at identifying athletes at risk for malignant arrhythmias should encompass athletes being considered for participation in esports. Although the appropriateness of such screening programs is outside the scope of this study, it certainly suggests that esports competitors should be treated similar to traditional athletes with respect to sudden death risk stratification.”

Reference: