Sudden Cardiac Deaths of Two Adolescents Associated with Vaping

Background: E-cigarettes have been available on the international market since 2007 and are promoted as a healthy alternative compared with traditional tobacco cigarettes. A nicotine-based liquid is aerosolized and inhaled, with varying proportions of nicotine, flavorings, vegetable glycerine (VG), and propylene glycerol (PG), making them very popular among adolescents. The pharmacokinetics and the toxicity of the components and the acute or chronic effects are not yet well understood. In adults, several cases of sudden cardiac arrest (SCA) associated with the use of e-cigarettes or vaping products have been reported.

Methods: We report on our experience with two adolescents who suffered SCA after using vaping products.

Results: A 13-year-old boy drowned after jumping into a swimming pool. Prior to the accident, he had used an e-cigarette several times. He had to be resuscitated due to persistent ventricular fibrillation and achieved return of spontaneous circulation (ROSC) after two defibrillations. The ECG and genetic testing showed no evidence of an inherited arrhythmogenic disorder, but Klinefelter’s syndrome was found. A 16-year-old girl collapsed and received immediate CPR. She was found to be in ventricular fibrillation, resuscitated, and stabilized with ROSC after one defibrillation. She had used a vaping device and consumed an energy drink shortly before. Blood tests were positive for ParvoB19 DNA, but the cardiac biopsy showed no viral infection. Genetic testing diagnosed catecholaminergic polymorphic ventricular tachycardia (CPVT), leading to a recommendation for ICD implantation and treatment with flecainide and bisoprolol.

Conclusion: Our two cases suggest that vaping may also trigger an arrhythmogenic event in children. Nicotine as one ingredient with general sympathetic activation has been shown to provoke tachycardia and hypertension, reduce myocardial blood flow, and induce coronary arterial spasms; other components (acrolein and aldehyde subtypes as degradation products) have been found to provoke arrhythmias in cases of underlying long QT syndrome, as well as repolarization changes and ventricular tachycardia independently. Therefore, cautious use of e-cigarettes or vaping products in children, especially those with underlying arrhythmogenic disorders, is recommended.

Publication History

Article published online:
11 February 2025