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.

Media Use Is Linked to Lower Psychological Well-Being: Evidence from Three Datasets

Adolescents spend a substantial and increasing amount of time using digital media (smartphones, computers, social media, gaming, Internet), but existing studies do not agree on whether time spent on digital media is associated with lower psychological well-being (including happiness, general well-being, and indicators of low well-being such as depression, suicidal ideation, and suicide attempts). Across three large surveys of adolescents in two countries (n = 221,096), light users (<1 h a day) of digital media reported substantially higher psychological well-being than heavy users (5+ hours a day). Datasets initially presented as supporting opposite conclusions produced similar effect sizes when analyzed using the same strategy. Heavy users (vs. light) of digital media were 48% to 171% more likely to be unhappy, to be in low in well-being, or to have suicide risk factors such as depression, suicidal ideation, or past suicide attempts. Heavy users (vs. light) were twice as likely to report having attempted suicide. Light users (rather than non- or moderate users) were highest in well-being, and for most digital media use the largest drop in well-being occurred between moderate use and heavy use. The limitations of using percent variance explained as a gauge of practical impact are discussed.

Internet use and electronic gaming by children and adolescents with emotional and behavioural problems in Australia - results from the second Child and Adolescent Survey of Mental Health and Wellbeing

BACKGROUND

Concerns have been raised of a potential connection between excessive online activity outside the academic realm and increased levels of psychological distress in young people. Young Minds Matter: the second Australian Child and Adolescent Survey of Mental Health and Wellbeing provides estimates of the prevalence of online activity and allows an exploration of associations between this activity, a range of mental disorders, socio-demographic characteristics and risk taking behaviour.

METHODS

Based on a randomized nationally representative sample, a household survey of mental health and wellbeing (Young Minds Matter) was conducted in 2013-14. Interviews were conducted with 6,310 parents and carers of 4-17 year-olds (55 % response rate), together with self-report questionnaires completed by 2,967 11-17 year-olds in these households (89 % response rate). The survey identified a range of mental disorders and emotional problems using a variety of diagnostic tools, with the self-report including questions about use of the Internet and electronic games. Five behaviours were measured related to this activity, with 'problem behaviour' being defined as exhibiting at least four out of five behaviours.

RESULTS

Levels of Internet use (98.9 %, CI 98.5-99.3 %) and electronic gaming (85.3 %, CI 83.9-86.6 %) were high, and 3.9 % (CI 3.2-4.6 %) of young people reported problem behaviour. The proportion of girls with very high levels of psychological distress and problem behaviour (41.8 %,CI 28.8-54.9 %) was twice that for boys (19.4 %, CI 7.7-31.1 %). Those engaging with a range of risk factors reported higher prevalence of problem behaviour than others. Youth who suffered from emotional problems or high levels of psychological distress spent the most time online or playing games. Multivariate analysis showed associations with problem behaviour and having attempted suicide, experiencing high to very high levels of psychological distress, using alcohol, and living in a poorly functioning family. It was not possible to determine the direction of the associations.

CONCLUSION

There are links between problem behaviours associated with Internet use and electronic gaming, and mental disorders and risk-taking behaviour in young people. Further studies are required to determine whether these are precursors or sequelae.