ArticleFrontiers in sports and active living2026
Mechanisms of drowning in children: influence of cold shock response on repolarization patterns and arrhythmia burden in healthy children.
Article in Frontiers in sports and active living, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: While drowning plays a particularly important role in children, the data on the physiology of drowning in this population are scarce. Both the cold shock response and the development of arrhythmias within the context of an autonomic conflict may be of particular significance during drowning. The cold shock response has now been outlined by our working group, while the effect of cold water on cardiac repolarization remains unclear. This study aims to provide a more detailed examination of the effects of cold shock response in healthy children, focusing on changes in repolarization patterns and the development of arrhythmias to enhance the knowledge on drowning mechanisms in children. Methods: Participants were first immersed up to the neck in warm water (34 °C) and then in cold water (11 °C), while skin temperature, heart rate and respiratory rate were continuously measured and ECG and Holter-ECG were recorded. Results: Heart rate variability parameters were lower in cold water compared to warm water. In cold water, the Tp-Te interval was significantly shorter compared to baseline in air. Additionally, QT interval did not adequately adapt to the sudden increase in heart rate during cold water immersion. Despite premature contractions regardless of immersion, no arrhythmias were detected. Conclusion: The current study presents first exploratory data on repolarization patterns and arrhythmia burden in healthy children during the immersion into 11 °C (52°F) cold water. Data suggest, that cold water immersion represents a strong sympathetic stressor and may be associated with a mild QT hysteresis and a distinct influence on the transmural gradient of repolarization. Although no arrhythmias were detected during cold water immersion in healthy children, the cold shock response itself appears to have some influence on repolarization parameters and may have the potential to contribute to the development of repolarization abnormalities in individuals with pre-existing conditions. Due to the standardized and controlled study conditions and the isolated investigation of a specific physiological mechanism, the findings cannot be directly extrapolated to the complex real-life scenario of drowning.
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