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Ventricular arrhythmia and electronic gaming
A fascinating letter in the New England Journal of Medicine highlighted yet another risk to electronic gaming (Lawley CM et al [N Engl J Med 2019; 381:1180–1181. DOI: 10.1056/NEJMc1905537]). Children and young adults who may not be able to play active sports due to their underlying cardiac condition may continue to be in danger while playing on a gaming station. This team reports four episodes of syncope in three children due to ventricular tachycardia or ventricular fibrillation while playing electronic games. One child had a diagnosis of catecholaminergic polymorphic ventricular tachycardia. Another child had a rapid monomorphic ventricular tachycardia was diagnosed and successfully cardioverted in the emergency department. An implantable cardioverter–defibrillator (ICD) was placed but 2 months later, he had another episode while playing the same game with successful cardioversion by the ICD. After a collapse while playing the game, the third child was investigated and had a QT interval corrected for heart rate of 570 msec. A diagnosis of long-QT syndrome was made. These dysrrthmias all occurred as the children were about to win the game. The possible mechanisms are discussed. Fascinating.
Migraines and antagonism of the calcitonin gene-related peptide pathway
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Provenance and peer review Commissioned; internally peer reviewed.