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
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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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