A. Graham Stuart

AR Pelletier

B Wu

Craig A. Williams

Deirdre Wilson

Guido E. Pieles

J Kuschyk

National Safety Council

R Hanada

SD Pringle

Simon M. Collin

Teresa Blackwell

Victoria Husk

English

Crossref

ORIGINAL ARTICLEHigh g-Force Rollercoaster Rides Induce Sinus Tachycardiabut No Cardiac Arrhythmias in Healthy ChildrenGuido E. Pieles1,2 • Victoria Husk1 • Teresa Blackwell1 • Deirdre Wilson1 •Simon M. Collin3 • Craig A. Williams4 • A. Graham Stuart1Received: 13 June 2016 / Accepted: 7 September 2016 / Published online: 21 September 2016 The Author(s) 2016. This article is published with open access at Springerlink.comAbstract Theme park operators and medical professionalsadvise children with heart conditions against using roller-coaster rides, but these recommendations are not evidence-based. The underlying assumption is that the combinationof adrenergic stimulation through stress and accelerationmight trigger arrhythmias in susceptible individuals. Weconducted a cross-sectional observational study to assessheart rate and rhythm in healthy children during commer-cial rollercoaster rides. Twenty healthy children (9 male)aged 11–15 (mean 13.3 ± 1.4) years underwent continuousheart rate and rhythm monitoring (2-lead ECG) from 5 minbefore until 10 min after each of 4 high speed([50 km h-1), high g-force ([4) commercial rollercoasterrides. Total recording time was 13 h 20 min. No arrhyth-mic events were detected. Resting heart rate was 81 ± 10b min-1 and increased to 158 ± 20 bmin-1 during rides.The highest mean HR (165 ± 23 b min-1) was observedon the ride with the lowest g-force (4.5 g), but one of thehighest speeds (100 km h-1). Anticipatory tachycardia(126 ± 15 b min-1) within 5 min was frequently observed.A 10 min recovery HR (124 ± 17 b min-1) was 56 %greater than resting HR. The speed and g-force experiencedon roller coasters induce sinus tachycardia but do not elicitpathological arrhythmias in healthy children.Keywords Cardiology  Arrhythmia  Rollercoaster g-forceIntroductionTheme parks are popular with children and adults. In theUK, the three biggest theme parks had 6.9 million visitorsin 2014, a 4.7 % increase compared to 2013 [1]. Atten-dance at a theme park is regarded as safe, with an injuryrisk requiring hospitalisation of 1 in 24 million [2]. In theUS, approximately 40 deaths over 10 years wereattributable to rollercoaster rides, five of which were inchildren with a suspected cardiac or respiratory cause [3].Although theme park ride operators and medical profes-sionals advise children with heart conditions against usingthe rides, these recommendations are based on consensus,not on scientific evidence.A primary concern is that the combination of adrenergicstimulation through stress and acceleration (g-force; g)experienced on roller coasters might trigger arrhythmias insusceptible individuals [4]. Studies from aviation sciencehave demonstrated that high g can provoke atrial andventricular ectopics, paroxysmal supraventricular tachy-cardia, paroxysmal atrial fibrillation but also sustainedventricular tachycardias [5]. Research on the cardiovas-cular effect of rollercoaster rides has been confined toadults participating in older style rides which have rela-tively low g generation. However, these studies havereported asymptomatic supraventricular arrhythmias, non-sustained ventricular tachycardia and even aortic& Guido E. Pielesguido.pieles@bristol.ac.uk1 Bristol Congenital Heart Centre, The Bristol Heart Institute,University Hospitals Bristol NHS Foundation Trust, Bristol,UK2 National Institute for Health Research (NIHR)Cardiovascular Biomedical Research Unit, Bristol HeartInstitute, University of Bristol, Bristol, UK3 Centre for Child and Adolescent Health, School of Social andCommunity Medicine, University of Bristol, Bristol, UK4 Children’s Health and Exercise Research Centre, College ofLife and Environmental Sciences, University of Exeter,Exeter, UK123Pediatr Cardiol (2017) 38:15–19DOI 10.1007/s00246-016-1477-5dissection [6, 7]. To the best of the authors knowledge,there have been no reported studies on the cardiovasculareffects of rollercoaster rides in children or adolescents.This is the first study to investigate the effect of modernhigh g rollercoaster rides on heart rhythm in healthychildren.Patients and MethodsTwenty healthy children (9 male), mean age of13.3 ± 1.5 years underwent a cardiovascular examination,medical and family history questionnaire and 12-lead ECGprior to the study. Patients with an abnormal cardiovascularexamination, history or ECG were excluded from thestudy. Whilst at the theme park, participants wore a 2-leadambulatory ECG monitor (R test evolution 4, Novacor).After manual activation, data were recorded continuouslyfrom 5 min before rollercoaster rides (anticipatory period)until 10 min after the ride (recovery period) on four rides.The maximum g was 5 g (mean 4.7 ± 0.2 g), maximumspeed was 130 km h-1 (mean 92 ± 48.2 km h-1), and theaverage ride time was 82 ± 36 s with breaks of a mini-mum of 45 min between rides (Table 1). Data were anal-ysed using dedicated offline software (RT Soft Ultima,Novacor) by one investigator trained in paediatric ECGanalysis (GEP), blinded to the type of ride and identifica-tion of participant.Statistical AnalysisAll data are presented as mean (SD) and mean difference[95 % CI] unless otherwise stated. The mean resting,anticipatory, maximum and recovery heart rates (HR) werecompared with baseline HR for each ride using Student’s ttest. Random effects linear regression models adjusted forage and resting HR were used to investigate differences inmaximum, recovery and anticipatory HR by ride and bysex. All analyses were performed using Stata (StataCorp2013. Stata Statistical Software: Release 13. College Sta-tion, TX: StataCorp LP).ResultsThe baseline 12-lead ECG showed a mean resting HR of81 ± 10 b min-1. No baseline 12-lead ECG abnormalitieswere detected. During the data collection at the theme park,total ECG recording time was 13 h 20 min with 59 indi-vidual ride recordings. Nineteen out of twenty participantsexperienced sinus tachycardia (HR[ 100 b min-1), with214 episodes of tachycardia recorded (Table 1; Fig. 1). Nopathological arrhythmias were detected.All rides induced a significant HR increase (p\ 0.001).Different effect on HR of speed vs g was also investigated.Maximum HR on Ride 1, with higher speed but lower gcompared to Ride 4, was higher by 20 [95 % CI 9–30]b min-1, p\ 0.001. Ride length did not affect the degreeof tachycardia.Overall, there was a slight tendency for boys to havelower maximum HR than girls (difference -11 [-28 to 7]b min-1, p = 0.23) (Table 1; Fig. 1).There was a significant anticipatory tachycardia (meandifference from resting HR 46 [41–51] b min-1,p\ 0.001) in 96 % of data points. Anticipatory HR waslower in boys than in girls (difference -18 [-28 to -8]b min-1, p = 0.001).HR at 10 min recovery was significantly higher thanresting HR (difference 44 [39–49] b min-1, p\ 0.001).There were no differences in mean HR at 10 min recoverybetween Rides 1–3, although it was slightly higher for Ride4 with the highest g compared to Ride 1 (difference 14[1–26] b min-1, p = 0.03). Recovery HR was also lowerin boys than in girls (difference -12 [-23 to -1] b min-1,p = 0.03) (Table 1).DiscussionThe aim of this study was to investigate the cardiovascularstress elicited during rollercoaster rides in young boys andgirls. Specifically, we recorded 2-lead ECG traces toestablish the incidence of any atrial and ventricular ecto-pics, paroxysmal supraventricular tachycardia, paroxysmalatrial fibrillation or sustained ventricular tachycardia.Although this is a small study, it is the first report of theeffects of high speed and high g on HR response andarrhythmia induction in healthy children participating in ahigh g roller coaster. This lack of paediatric data is sur-prising considering the numbers of riders annually in themeparks around the world.Our results showed a significant increase in HR duringrollercoaster rides from baseline resting HR (p\ 0.001 forall rides), the levels of which are comparable to HR duringmoderate exercise. Although sudden sympathetic activa-tion, as experienced on roller coasters, is one mechanism ofpathological arrhythmia induction, in contrast to adultstudies, we have, however, not observed any episodes ofabnormal rhythm in children. However, significant sinustachycardia occurred in 95 % of children which is a muchhigher frequency than the 44 % reported in adults [7].Remarkably, a tachycardic response was not confined toperiods on rides, but we recorded significant (p\ 0.001)tachycardia 5 min before the ride indicating that part of thetachycardia effect is not related to speed or g but is ananticipatory response, which was more pronounced in girls.16 Pediatr Cardiol (2017) 38:15–19123Table1Rollercoasterridecharacteristicsandheartrate(HR)measurementsMaxSpeed(km-1)Maxg-forceMaxheight(m)Lengthofride(m)Durationofride(s)SexofriderNumberofridersBaseline(resting)HR(bmin-1)AnticipatoryHR(bmin-1)MaxHR(bmin-1)RecoveryHRat10min(bmin-1)HRchangefromrestingtomax(bmin-1)HRchangefromrestingtorecovery(bmin-1)Ride11004.539775125Both1783(9)122(13)165(23)126(12)82[70,95]***43[37,50]***Boys784(6)114(10)152(21)123(10)93[78,107]***46[36,90]***Girls1082(11)128(12)174(20)128(13)68[47,89]***39[31,47]***Ride21304.562.550024Both1781(11)133(11)158(17)119(14)78[70,86]***38[30,47]***Boys981(9)126(7)152(15)113(9)71[61,81]***33[22,43]***Girls881(12)140(10)166(16)126(17)85[72,98]***46[29,62]**Ride3894.830700100Both1582(10)128(19159(17)119(16)77[68,87]***40[30,49]***Boys582(7)124(12)151(10)115(23)69[54,83]***33[7,59]*Girls1082(11)130(23)163(19)122(12)82[68,95]***43[33,54]***Ride450518–120Both1079(10)118(13)142(19)139(25)63[53,72]***57[41,73]***Boys481(12)113(13)144(18)135(30)63[38,88]**54[18,89]*Girls678(9)128(3)140(21)143(23)62[48,76]***60[33,88]**Allrides92(48)4.7 (0.2)37(16)658 (116)92(41)Both1781(10)126(15)158(20)124(17)76[71,81]***44[39,49]***Boys981(9)120(11)151(16)120(18)68[62,75]***38[31,45]***Girls1181(11)132(15)163(21)128(16)82[75,89]***48[41,55]***HRmeasurementsandcharacteristicsof‘Allrides’areshownasmean(SD).HRchangefromrestingisshownasmean[95%CI].Ride1isa‘wingcoaster’,onwhichtheriderexperiencesfiveinversions(loops).Ride2isalaunchrollercoaster,acceleratingfrom0to130kminunder2stoaheightof205ft,beforedroppingbackdown.Ride3isa‘Euro-Fighter’rollercoaster,100sofahauntedhousethemeandblindverticaldrops(freefalls).Ride4haslongarms,whichspinrelentlesslyaround360degreepivotsfor180s*p\0.05;**p\0.01;***p\0.001Pediatr Cardiol (2017) 38:15–19 17123We also investigated the differential effects of speed andg on HR response. Rollercoaster rides with the highestspeeds (rides 1 and 2) evoked a more pronounced tachy-cardia response than rides with higher g (rides 3 and 4).This suggests that acceleration to a greater maximal speedmight play a greater part in triggering tachycardia than theeffect of the g exerted. In contrast, a higher g but lowerspeed had a negative effect on HR recovery (Table 1).Sample size was a limitation.ConclusionThis pilot study showed for the first time that there issignificant sinus tachycardia, but no arrhythmia inductionin response to anticipation, stress, catecholamine releaseand g exerted by modern theme park rides in healthychildren. Permission to participate in rollercoaster rides andsimilar fairground activities is often sought by families ofchildren with a variety of medical conditions. Although thisis a small study, we hope that the detailed data obtained canhelp the paediatrician to give more informed advice.Acknowledgments This work was supported by the National Insti-tute for Health Research (NIHR) Biomedical Research Unit in Car-diovascular Disease at the University Hospitals Bristol NHSFoundation Trust and the University of Bristol. Dr Pieles is the holderof an NIHR Academic Clinical Lectureship in Paediatric Cardiology.We would like to thank Novacor Ltd (Swanley, Kent, UK) for pro-viding portable ECG monitoring equipment and Thorpe Park (MerlinEntertainments PLC, Poole, Dorset, UK) for their support during dataacquisition. We thank all of the children and their families for par-ticipating in this study.Compliance with Ethical StandardsConflict of interest The authors have no commercial or other asso-ciations that might pose a conflict of interest in connection to thesubmitted article. The authors had full control of the design of thestudy, methods used, outcome parameters, analysis of the data andproduction of the manuscript.Ethical approval All procedures performed were in accordance withthe ethical standards of the institutional research committee and withthe 1964 Helsinki Declaration and its later amendments or compa-rable ethical standards.Informed consent Informed consent was obtained from all individ-ual participants included in the study (written consent from parentsand written assent from children).Open Access This article is distributed under the terms of theCreative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,distribution, and reproduction in any medium, provided you giveappropriate credit to the original author(s) and the source, provide alink to the Creative Commons license, and indicate if changes weremade.References1. TEA/AECOM (2014) Theme Index & Museum Index: The GlobalAttractions Attendance Report. Themed Entertainment Associa-tion (TEA), Burbank, CAFig. 1 HR measurements(resting, anticipatory, maximaland 10 min recovery) across thefour rollercoaster rides18 Pediatr Cardiol (2017) 38:15–191232. National Safety Council (2014) Fixed-site Amusement Ride InjurySurvey, 2013 Update. NSC Research and Statistical ServicesGroup, Itasca, IL3. Pelletier AR, Gilchrist J (2005) Roller coaster related fatalities,United States, 1994–2004. Inj Prev 11:309–3124. Wu B, Xue Y, Wu P, Gu Z, Wang Y, Jing X (2012) Physiologicalresponses of astronaut candidates to simulated ?Gx orbitalemergency re-entry. Aviat Space Environ Med 83:758–7635. Hanada R, Hisada T, Tsujimoto T, Ohashi K (2004) Arrhythmiasobserved during high-G training: proposed training safety crite-rion. Aviat Space Environ Med 75:688–6916. Pringle SD, Macfarlane PW, Cobbe SM (1989) Response of heartrate to a roller coaster ride. BMJ 299:15757. Kuschyk J, Haghi D, Borggrefe M, Brade J, Wolpert C (2007)Cardiovascular response to a modern roller coaster ride. JAMA298:739–741Pediatr Cardiol (2017) 38:15–19 19123

Pediatric Cardiology

High g-Force Rollercoaster Rides Induce Sinus Tachycardia but No Cardiac Arrhythmias in Healthy Children

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High g-Force Rollercoaster Rides Induce Sinus Tachycardia but No Cardiac Arrhythmias in Healthy Children

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