Tetris 64 is a game that was released in Japan for the Nintendo 64. It included a "bio-sensor" that measured the player's heart rate, for use in the Bio Tetris mode, and was the only game for the Nintendo 64 to use the sensor.
- A-Type is a standard marathon mode. By default the player can start from levels 0 to 20, with subsequent starting levels available after reaching them in a game. Level increases at 10*(n+1) lines, so that the same number of lines need to be cleared regardless of the starting level.
- B-Type is divided into 30 levels (0-29) and 6 heights (0-5, corresponding to 0, 3, 6, 8, 10, 12 lines of garbage). Clearing 25 lines will pass the stage, causing the player to advance a height. Clearing height 5 will advance the level. An ending occurs on clearing level 29 height 5.
- C-Type is similar to A-Type, but garbage will rise from the bottom at certain intervals.
Giga Tetris sometimes gives the player giant pieces. When a line is made involving a giant piece, instead of clearing it will split into vertical dominoes. The dominoes will disappear if involved in a line clear. The mode also has cascade gravity.
Based on the player's heart rate, the game would give out harder or easier pieces.
The game includes a surprising number of options, particularly regarding rotation. Moreover, enabling some of these options allows the player to perform unique spin moves, including an O-Spin (though these are not recognised by the game).