For children with heart conditions, video gaming may pose a health hazard

Video games often get a bad rep for encouraging the couch potato lifestyle. But anyone who’s gone up against unrelenting ‘Elden Ring’ bosses or helped a stray cat pull a dystopian Free Willy, knows there’s something about gaming that gets the heart pumping and the blood flowing.

But can playing video games harm our cardiovascular systems? A new study published this month in the journal Heart Rhythm found that among nearly two dozen children and teens with a confirmed arrhythmia (where the heart beats irregularly), the researchers found video games — particularly war games — seemed to trigger their condition and, in some rare cases, led to death.

“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,” Claire M. Lawley, the study’s lead researcher and an investigator at The Heart Centre for Children in Sydney, Australia, said in a press release.

Here’s the background — It may seem curious that sitting in one place and smashing buttons on a game controller or keyboard can elicit such a strong physiological response. However, studies dating back to the 1990s show playing electronic games — which include any game on a console, computer, or even an arcade cabinet — can raise heart rate, blood pressure, and oxygen consumption.

In recent years, there have been reports of young people experiencing cardiac events and even death during or after these games. In 2013, news of a U.K. teen’s death by heart attack while playing Sonic the Hedgehog on his Xbox made international headlines. At the time, the cause of the young man’s death was attributed to sudden arrhythmic death syndrome, which is typically due to an inherited issue with the heart’s electrical system.

Other instances have also cropped up. In 2019, Lawley and colleagues reported three cases of boys between the ages of 10 and 15 who each lost consciousness while playing an electronic war game. All three of the boys were discovered to have rare and very serious underlying heart abnormalities, which was surprising for two of the boys since they never had issues like that before, reported WebMD at the time.

In 2020, one nine-year-old boy blacked out after losing a standoff in Fortnite Battle Royale. A battery of tests revealed the boy had catecholaminergic polymorphic ventricular tachycardia (or CPVT), a type of arrhythmia known to be triggered by physical or emotional stress.

How they did it — Looking to see if there was a common pattern of susceptibility or vulnerability behind the heart-electronic game connection, Lawley and her colleagues combed through the scientific literature for cases that mention video games and cardiac events such as blacking out, arrhythmia, heart attack, or sudden death together.

They identified 22 cases involving children and teens between the ages of seven and 16 years, who were mostly boys (only three cases reported involved girls). For the most part, falling unconscious while playing was a common complaint, but there were six cases of heart attack and four deaths due to cardiac arrest.

At the time of their cardiac event, six patients had just lost or won a game (and were jumping for joy). A seventh, in typical kid fashion, was fighting with his sibling over the game controller.

Lawley and her colleagues found that for 19 patients, only seven of them had a known heart issue before their gaming event, conditions such as CPVT, long QT syndrome (also known as LQTS) where abnormal electrical activity makes the heart beat really chaotic, and idiopathic ventricular fibrillation, which can cause sudden cardiac death and has no underlying genetic or anatomical cause.

Twelve other patients out of the 19 were diagnosed with several heart rhythm conditions after their gaming event, the most common diagnoses were CPVT and LQTS. In three patients (one alive and two dead), no formal diagnosis was reached at the time of publishing.

For the most part, the games were played on a gaming console or computer, with the exception of one kid who was watching an arcade game. The meatier question is exactly which kind of games, whether first-person shooter, Metroidvania, or RPG, were involved. Those details or game titles weren’t disclosed, but in at least eight out of the 22 cases, there was a war game at the center of it (although exactly which one also isn’t mentioned).

Delving into the genetics, the researchers discovered that 63 percent of patients carried “pathogenic” genes that put them at risk for developing heart rhythm issues like CPVT. This discovery led other family members to get themselves tested and, for some, finding out they, too, had arrhythmia. In the rest of the patients, genetic testing wasn’t done because either there was no way to get a sample (because of death) or the patient had another reason for their heart condition, like recent cardiac surgery.

Digging into the details — There are several caveats to this study to bear in mind. Because these findings are based on a collection of case reports, we don’t yet know the exact magnitude of this phenomenon — it could be much more, Lawley and her colleagues explain.

And aside from specific game titles, there’s other information we don’t have, Daniel Sohinki, a cardiologist at Augusta University Medical Center who wasn’t involved in the study, wrote in an accompanying editorial.

“It would be helpful for future studies to include additional case details of arrhythmia and [blacking out] events that may be of interest, such as consumption of caffeine, energy drink, or other stimulants, whether prescribed or illicit during gameplay, or any family history of sudden cardiac arrest or death,” he wrote.

“Future work also should consider including details of gaming at the time of an event, such as the duration of play, time of day, any physical exertion, type (and even title) of game, and competitiveness of play (i.e., higher stakes against peers),” Sohinki added.

Why it matters — The last several years have seen competitive physical sports like football and soccer sharing the limelight with professional gaming, popularly known as eSports. Despite being valued at $1.08 billion globally in 2021 and expected to rise to $2.8 billion dollars by 2028, the legitimacy of competitive gaming as a “sport” remains a point of contention.

But as this study suggests, it’s the intense, emotional involvement of gaming that can put vulnerable individuals at risk for life-threatening heart conditions, just as intense physical exertion can do the same for athletes.

“Given the similarities between this environment and the typical stresses of traditional competitive athletics, it is reasonable to assume that a certain subset of eSports ‘athletes’ may be at risk for cardiovascular complications during competitive play,” said Sohinki.

This means that just like with traditional athletes, we should highly consider heart screenings for eSports athletes to ensure their well-being.

“Video gaming was something I previously thought would be an alternative ‘safe activity,’” Christian Turner, a co-author of the paper and pediatric cardiologist at The Heart Centre for Children, said in a press release. “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.”