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J Am Coll Cardiol, 2003; 41:99-104
© 2003 by the American College of Cardiology Foundation
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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{dagger}, 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
{dagger} The Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA



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  		Figure 1 Incidence of ventricular fibrillation (VF) induced by chest-wall impact at the vulnerable period of repolarization, with a regulation baseball propelled at a range of velocities under controlled conditions (logistic regression model p < 0.0001 predicting VF from mph and mph2).

 


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  		Figure 2 Peak instantaneous left ventricular (LV) pressures generated by chest-wall blows correlate linearly with the velocity of impact. P value derived from logistic regression procedure predicting peak LV pressure from velocity and velocity2.

 


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  		Figure 3 Incidence of ventricular fibrillation (VF) with chest-wall impact plotted against the magnitude of left ventricular (LV) pressure rise and the magnitude of LV pressure over time (dP/dt) demonstrating a highly significant Gaussian curve. P value derived from logistic regression models predicting the probability of VF from the peak LV pressure and dP/dt.

 




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