Computer games can create life-threatening cardiac arrhythmias in vulnerable young people, the tendency of which may not have been previously reported, according to a new study.
Researchers have observed an unusual but distinct pattern in children who lose consciousness while playing video games.
The results of the study were published in the journal of the Heart Rhythm Society, the Cardiac Electrophysiology Society and the Pediatric & Congenital Electrophysiology Society.
“Video games can pose a serious risk to some children with arrhythmic conditions; they can be lethal in patients with predisposing but often previously unrecognized arrhythmic conditions,” explained principal investigator Claire M. Lawley, MBBS, PhD, The Heart Center for Children, Sydney Children’s Hospitals Network, Sydney, Australia. “Children who suddenly lose consciousness while playing electronics games should be evaluated by a cardiologist, as this could be the first sign of a serious heart condition.”
The investigators performed a systematic review of the literature and initiated an international outreach effort in multiple locations to identify cases of children experiencing sudden loss of consciousness while playing video games. In the 22 cases found, multiplayer war games were the most frequent trigger. Some children died after cardiac arrest. Subsequent diagnoses of various heart rhythm conditions put children at ongoing risk. Catecholaminergic polymorphic ventricular tachycardia (CPVT) and congenital long QT syndrome (LQTS) types 1 and 2 were the most common underlying causes.
There was a high incidence of potentially relevant genetic variants (63 percent) among patients, which has significant implications for their families. In some cases, the investigation of a child who lost consciousness while playing a video game has led to many family members being diagnosed with a major familial heart rhythm problem. “Families and healthcare teams should think about the safety precautions around playing electronic games in children who have a condition where rapid and dangerous heart rhythms are a risk,” noted Dr. Lawley.
Investigators have attributed adrenergic stimulation related to the emotionally charged electronic game environment as the pathophysiological basis of this phenomenon. Video games are not always the “safe alternative” to the competitive sports they are often considered to be. At the time of the cardiac incidents, many of the patients were in states of arousal, having just won or lost games, or in conflict with peers.
“We already know that some children have heart conditions that can put them at risk when playing competitive sports, but we were shocked to find that some patients were experiencing life-threatening blackouts while playing video games,” added co-investigator Christian Turner, MBBS, The Heart Center for Children, Sydney Children’s Hospitals Network, Sydney, Australia. “Video games were something I previously thought would be an alternative ‘safe activity’. This is a really important discovery. We need to make sure everyone knows how important it is to get checked out when someone has had a fainting episode under these circumstances.”
The study notes that while this phenomenon is not a common occurrence, it is becoming more prevalent. “Having cared for children with heart rhythm problems for over 25 years, I was shocked to see how widespread this emerging presentation is and to find that several children have died from it. All collaborators are eager to publicize this phenomenon so that our colleagues around the world can recognize it and protect these children and their families,” noted study co-investigator Jonathan Skinner, MBChB, MD, also of Sydney.
As an accompanying editorial, Daniel Sohinki, MD, MSc, Department of Cardiology, Augusta University, Augusta, GA, USA, and co-authors noted that “Exertion should be understood to encompass activities outside of traditional competitive athletics. Appropriate counseling about the risks of intense video gaming should be directed to children with a cardiac proarrhythmic diagnosis and any child with a history of exertional syncope of undetermined etiology. Rhythms should encompass athletes considered for participation in eSports.”