Upper and lower limits of vulnerability to sudden arrhythmic death with chest-wall impact (commotio cordis)

Abstract

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.

Part 12: Cardiac Arrest in Special Situations

“…Even a small blow to the anterior chest during a cardiac repolarization, such as that imparted by the strike of a baseball or hockey puck, may trigger VF, so-called commotio cordis. 405 Events causing commotio cordis are most commonly seen in young persons up to 18 years of age who are engaged in sports but may occur during daily activities. Prompt recognition that a precordial blow may cause VF is critical.…”

Atrial Fibrillation Induced by Commotio Cordis Secondary to a Blunt Chest Trauma in a Teenage Boy

“…The relatively low-energy impact has to occur during a critical 20-millisecond window of the cardiac repolarization and the impact has to be directly over the cardiac silhouette to induce VF. 11,12 It is plausible that if a low-energy chest wall impact occurs during the vulnerable window of atrial repolarization, the impactinduced elevated atrial pressure will trigger a premature atrial depolarization and the initiation of AF. As a result of the impact, the atrial tissue may exhibit a dispersion of refractoriness inducing a so-called heterogeneity of atrial repolarization, which can perpetuate and sustain AF.…”

Preventing sudden cardiac death in the young: Is electrocardiogram screening the most effective means?

“…Previously unsuspected genetic arrhythmias such as congenital long QT syndrome (LQTS), Viewpoint catecholaminergic polymorphic ventricular tachycardia (CPVT) and Brugada syndrome are causes that may account for as many as 40% of patients with a normal heart at autopsy (17)(18)(19). Although important, commotio cordis (nonpenetrating blunt trauma to the anterior thorax causing arrhythmia) is an acute event and will not be discussed further in the context of ECG screening (20).…”