CLINICAL STUDY: CARDIAC ARRHYTHMIAS
Upper and lower limits of vulnerability to sudden arrhythmic death with chest-wall impact (commotio cordis)
Mark S. Link, MD, FACC*,*,
Barry J. Maron, MD, FACC ,
Paul J. Wang, MD, FACC*,
Brian A. VanderBrink, BA*,
Wei Zhu, MD* and
N. A. Mark Estes, III, MD, FACC*
* Center for the Cardiovascular Evaluation of Athletes and the Cardiac Arrhythmia Service, New England Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
The Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
Manuscript received March 27, 2002;
revised manuscript received September 4, 2002,
accepted September 26, 2002.
* Reprint requests and correspondence: Dr. Mark S. Link, New England Medical Center, Box #197, 750 Washington Street, Boston, Massachusetts 02111, USA.
MLink{at}Lifespan.org
OBJECTIVES: In an animal model of commotio cordis, sudden death with chest-wall impact, we sought to systematically evaluate the importance of impact velocity in the generation of ventricular fibrillation (VF) with baseball chest-wall impact.
BACKGROUND: Sudden cardiac death can occur with chest-wall blows in recreational and competitive sports (commotio cordis). Analyses of clinical events suggest that the energy of impact is often not of unusual force, although this has been difficult to quantify.
METHODS: Juvenile swine (8 to 25 kg) were anesthetized, placed prone in a sling to receive chest-wall strikes during the vulnerable time window during repolarization for initiation of VF with a baseball propelled at 20 to 70 mph.
RESULTS: Impacts at 20 mph did not induce VF; incidence of VF increased incrementally from 7% with 25 mph impacts, to 68% with chest impact at 40 mph, and then diminished at  50 mph (p < 0.0001). Peak left ventricular pressure generated by the chest blow was related to the incidence of VF in a similar Gaussian relationship (p < 0.0001).
CONCLUSIONS: The energy of impact is an important variable in the generation of VF with chest-wall impacts. Impacts at 40 mph were more likely to produce VF than impacts with greater or lesser velocities, suggesting that the predilection for commotio cordis is related in a complex manner to the precise velocity of chest-wall impact.
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Abbreviations and Acronyms
| | dP/dt | | left ventricular pressure rise over time | | ECG | | electrocardiogram | | LV | | left ventricle or left ventricular | | VF | | ventricular fibrillation |
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