14th International Congress
THE "NEW FRONTIERS"
OF ARRHYTHMIAS 2000

Jan. 29 - Feb. 5, 2000
Marilleva, Trento, Italy

RT-69

Commotio cordis: sudden death due to chest wall trauma

MarkS. Link, Paul J.Wang, Munther K. Homoud, Mark Estes III.
The New England Cardiac Arrhythmia Center, Tufts University School of Medicine, New England Medical Center, Washington, USA

Introduction

Over two decades ago, ventricular fibrillation following chest wall trauma during athletics was initially described¹. Subsequently, instantaneous death during athletic activities has been described from relatively low impact blows to the chest from a baseball, softball, hockey puck, fist, or other seemingly “innocent blows” to the chest wall^2-9. Although the precise incidence of commotio cordis is unknown there is likely underreporting from misclassification of many deaths due to this condition. An international registry has collected over 90 well documented cased in the last three years of commotio cordis^9,10.

With the development of a biological model for commotio cordis, there has been significant progress in understanding its fundamental mechanism. Based on observations in the experimental model, it has become evident that ventricular fibrillation results in low energy chest wall impact during the vulnerable period of repolarization corresponding to the peak of the T wave⁶. In addition, preliminary data indicates that the risk of commotio cordis can be reduced by modification of existing athletic equipment including the use of safety baseballs¹⁰. Finally, it appears that prompt defibrillation is a critical determinant of successful resuscitation¹¹.