Electronic games can trigger potentially fatal cardiac arrhythmias in susceptible children: Video games may not always be a safe alternative to competitive exercise, according to a new study in Heart Rhythm

“Video games may pose a serious risk to some children with cardiac arrhythmia; they can be fatal in patients with predisposing but often previously unrecognized cardiac arrhythmias,” said study 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 electronic games should be evaluated by a heart specialist as this could be the first sign of a serious heart problem.”

Investigators conducted a systematic literature review and initiated an international outreach at multiple sites to identify cases of children with sudden loss of consciousness while playing video games. In the 22 cases found, multiplayer war gaming was the most common trigger. Some children died after cardiac arrest. Subsequent diagnoses of multiple cardiac arrhythmias put the 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%) among patients, with significant implications for their families. In some cases, the evaluation of a child who lost consciousness while playing a video game led to many family members being diagnosed with an important familial heart rhythm problem. “Families and healthcare teams should consider safety precautions related to electronic gaming in children who have a condition that puts dangerously fast heart rhythms at risk,” noted Dr. Lawley.

The researchers cited adrenergic stimulation associated with the emotionally charged electronic gaming environment as the pathophysiological basis for this phenomenon. Electronic gambling is not always the “safe alternative” to competitive sports, it is often assumed. At the time of the heart attacks, many of the patients were in agitated states, had just won or lost games, or had conflicts with their companions.

“We already know that some children have heart problems that can put them at risk when competing, but we were shocked to find that some patients had life-threatening blackouts while playing video games,” added co-investigator Christian Turner, MBBS. The Children’s Heart Center, Sydney Children’s Hospitals Network, Sydney, Australia. “Video games were something I used to think would be an alternative ‘safe activity’. This is a really important discovery. We need to make sure everyone knows the importance of getting checked out if someone has had a blackout episode in these circumstances.”

The study notes that while this phenomenon is not common, it is becoming more common. “Having cared for children with arrhythmias for more than 25 years, I was amazed to see how widespread this emerging presentation is and to discover that a number of children have even died from it. All of the staff are keen to publicize this phenomenon so that our colleagues around the world can recognize it and protect these children and their families,” noted study co-researcher Jonathan Skinner, MBChB, MD, also of Sydney.

In 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 include activities outside of traditional athletics and include intense video gaming.” should be sought in children with a proarrhythmic cardiac diagnosis and in all children with a history of exertional syncope of undetermined etiology. In addition, any future screening programs aimed at identifying athletes at risk for malignant arrhythmias should include athletes considered for the Participate in eSports.”

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