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A new study suggests that video games are not always a safe alternative to sports. A recent study published in Heart Rhythm, the official journal of the Heart Rhythm Society, the Cardiac Electrophysiology Society, and the Pediatric & Congenital Electrophysiology Society, by Elsevier, found that playing electronic games can trigger cardiac arrhythmias in susceptible children whose predisposition may have been previously unrecognized. The researchers discovered a rare yet distinct pattern in children who lose consciousness while playing electronic (video) games. "Video games may represent a serious risk to some children with arrhythmic conditions; they might be lethal in patients with predisposing, but often previously unrecognized arrhythmic conditions," explained lead investigator Claire M. Lawley, MBBS, Ph.D., The Heart Centre for Children, Sydney Children's Hospitals Network, Sydney, Australia. "Children who suddenly lose consciousness while electronic gaming should be assessed by a heart specialist as this could be the first sign of a serious heart problem." The researchers conducted a systematic review of the literature and launched a multi-site worldwide outreach campaign to identify examples of children who had a sudden loss of consciousness while playing video games. The most common trigger in the 22 instances they discovered was multiplayer war gaming. Some of the children died as a result of cardiac arrest. The children continue to be at risk as a result of subsequent diagnoses of various cardiac rhythm disorders. The most common underlying causes were catecholaminergic polymorphic ventricular tachycardia (CPVT) and congenital long QT syndrome (LQTS) types 1 and 2. There was a high prevalence of potentially relevant genetic variations (63%) among the patients, which has important implications for their families. In some instances, the investigation of a child who lost consciousness while playing video games resulted in the diagnosis of several family members with a serious familial heart rhythm problem. "Families and healthcare teams should think about safety precautions around electronic gaming in children who have a condition where dangerous fast heart rhythms are a risk," noted Dr. Lawley. The investigators attributed adrenergic stimulation related to the emotionally charged electronic gaming environment as the pathophysiological basis for this phenomenon. Electronic gaming is not always the "safe alternative" to competitive sports it is often considered. At the time of the cardiac incidents, many of the patients were in excited states, having just won or lost games, or were engaging in conflict with companions. "We already know that some children have heart conditions that can put them at risk when playing competitive sports, but we were shocked to discover that some patients were having life-threatening blackouts during video gaming," added co-investigator Christian Turner, MBBS, The Heart Centre for Children, Sydney Children's Hospitals Network, Sydney, Australia. "Video gaming was something I previously thought would be an alternative 'safe activity.' This is a really important discovery. We need to ensure everyone knows how important it is to get checked out when someone has had a blacking out episode in these circumstances." The study notes that while this phenomenon is not a common occurrence, it is becoming more prevalent. "Having looked after children with heart rhythm problems for more than 25 years, I was staggered to see how widespread this emerging presentation is, and to find that a number of children had even died from it. All of the collaborators are keen to publicize this phenomenon so our colleagues across the globe can recognize it and protect these children and their families," noted co-investigator of the study, Jonathan Skinner, MBChB, MD, also from Sydney. As an accompanying editorial Daniel Sohinki, MD, MSc, Department of Cardiology, Augusta University, Augusta, GA, USA, and coauthors pointed out that, "exertion should be understood to encompass activities outside of traditional competitive athletics. Appropriate counseling regarding the risks of intense video gameplay should be targeted in children with a pro-arrhythmic cardiac diagnosis, and in any child with a history of exertional syncope of undetermined etiology. Further, any future screening programs aimed at identifying athletes at risk for malignant arrhythmias should encompass athletes being considered for participation in eSports."
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