Ventricular Fibrillation Triggered by Chest Impact–Induced Abnormalities in Repolarization
Commotio cordis is a phenomenon in which a sudden blunt impact to the chest causes sudden death in the absence of cardiac damage. This condition was first described in the middle of the 18th century in the context of chest trauma among workers.1 Through most of the 20th century, it was only sporadically reported. In the last 2 or 3 decades, commotio cordis events have primarily occurred in sports, and thus, this phenomenon has become more well known to the sports communities and physicians.2–4 Commotio cordis is to be differentiated from cardiac contusion (contusio cordis), a situation in which blunt chest trauma causes structural cardiac damage, such as observed in motor vehicular accidents.
Commotio Cordis in Humans
Approximately 10 to 20 cases are added to the Commotio Cordis Registry yearly.3,4 Until the late 1990s, commotio cordis was only rarely reported. It is thought that this increase in the number of cases is not due to an increase in incidence but rather to a greater awareness based on the 1995 New England Journal of Medicine report on commotio cordis.2 Many more cases of commotio cordis are now recognized as such. Indeed, what was thought to be a uniquely North American phenomenon is increasingly being reported in countries outside the United States.5
Commotio cordis primarily affects young individuals, generally in adolescence. In the Registry, the mean age is 15 years4; there have been very few commotio cordis victims over the age of 20 years. It traditionally has been thought that the stiffening of the chest wall contributes to this decrease in incidence in older individuals; however, this decreased incidence in those over 20 years of age is likely also influenced by the reduced ball-related sports participation by older individuals. Victims are overwhelmingly male. A partial …