- Mark S Link, MD
Mark S Link, MD
- Section Editor — Cardiac Arrhythmias
- Professor of Medicine
- UT Southwestern Medical Center
Commotio cordis, which translates from a Latin origin as "agitation of the heart," is defined as sudden cardiac death secondary to relatively innocent chest wall impact. As one of the more common causes of sudden cardiac death in young athletes (along with hypertrophic cardiomyopathy and congenital anomalies of the coronary arteries), commotio cordis has received significant media attention because of the increased awareness of sudden cardiac death that occurs during sports [1-6].
The epidemiology, potential mechanisms, treatment, and primary prevention of commotio cordis will be discussed here. Other common causes of sudden cardiac death are discussed in detail separately. (See "Overview of sudden cardiac arrest and sudden cardiac death" and "Risk of sudden cardiac death in athletes" and "Sudden cardiac arrest in the absence of apparent structural heart disease" and "Hypertrophic cardiomyopathy: Assessment and management of ventricular arrhythmias and sudden cardiac death risk".)
Reports of sudden cardiac death following chest trauma have appeared in the medical literature since the 1700s . While the exact incidence of commotio cordis remains unknown, mostly due to a lack of systematic reporting of cases, commotio cordis has been reported as the second most common cause of sudden death in athletics (behind hypertrophic cardiomyopathy) .
In the mid-1990s, the National Commotio Cordis Registry was established in the United States as a means of collecting data systematically on cases of commotio cordis.
Since the National Commotio Cordis Registry was established, data on over 200 confirmed cases of commotio cordis have been published [3,8]. Some notable findings from the registry include:
- Maron BJ, Gohman TE, Kyle SB, et al. Clinical profile and spectrum of commotio cordis. JAMA 2002; 287:1142.
- Madias C, Maron BJ, Weinstock J, et al. Commotio cordis--sudden cardiac death with chest wall impact. J Cardiovasc Electrophysiol 2007; 18:115.
- Maron BJ, Estes NA 3rd. Commotio cordis. N Engl J Med 2010; 362:917.
- Kohl P, Nesbitt AD, Cooper PJ, Lei M. Sudden cardiac death by Commotio cordis: role of mechano-electric feedback. Cardiovasc Res 2001; 50:280.
- Link MS, Estes NA. Athletes and arrhythmias. J Cardiovasc Electrophysiol 2010; 21:1184.
- Maron BJ. Sudden death in young athletes. N Engl J Med 2003; 349:1064.
- Maron BJ, Doerer JJ, Haas TS, et al. Historical observation on commotio cordis. Heart Rhythm 2006; 3:605.
- Link MS. Commotio cordis: ventricular fibrillation triggered by chest impact-induced abnormalities in repolarization. Circ Arrhythm Electrophysiol 2012; 5:425.
- Maron BJ, Ahluwalia A, Haas TS, et al. Global epidemiology and demographics of commotio cordis. Heart Rhythm 2011; 8:1969.
- Link MS, Wang PJ, Pandian NG, et al. An experimental model of sudden death due to low-energy chest-wall impact (commotio cordis). N Engl J Med 1998; 338:1805.
- Link MS, Estes NA 3rd, Maron BJ, American Heart Association Electrocardiography and Arrhythmias Committee of Council on Clinical Cardiology, Council on Cardiovascular Disease in Young, Council on Cardiovascular and Stroke Nursing, Council on Functional Genomics and Translational Biology, and American College of Cardiology. Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 13: Commotio Cordis: A Scientific Statement From the American Heart Association and American College of Cardiology. Circulation 2015; 132:e339.
- Link MS, Maron BJ, VanderBrink BA, et al. Impact directly over the cardiac silhouette is necessary to produce ventricular fibrillation in an experimental model of commotio cordis. J Am Coll Cardiol 2001; 37:649.
- Link MS, Maron BJ, Wang PJ, et al. Upper and lower limits of vulnerability to sudden arrhythmic death with chest-wall impact (commotio cordis). J Am Coll Cardiol 2003; 41:99.
- Link MS, Maron BJ, Wang PJ, et al. Reduced risk of sudden death from chest wall blows (commotio cordis) with safety baseballs. Pediatrics 2002; 109:873.
- Kalin J, Madias C, Alsheikh-Ali AA, Link MS. Reduced diameter spheres increases the risk of chest blow-induced ventricular fibrillation (commotio cordis). Heart Rhythm 2011; 8:1578.
- Bode F, Franz MR, Wilke I, et al. Ventricular fibrillation induced by stretch pulse: implications for sudden death due to commotio cordis. J Cardiovasc Electrophysiol 2006; 17:1011.
- Link MS, Wang PJ, VanderBrink BA, et al. Selective activation of the K(+)(ATP) channel is a mechanism by which sudden death is produced by low-energy chest-wall impact (Commotio cordis). Circulation 1999; 100:413.
- Garan AR, Maron BJ, Wang PJ, et al. Role of streptomycin-sensitive stretch-activated channel in chest wall impact induced sudden death (commotio cordis). J Cardiovasc Electrophysiol 2005; 16:433.
- Stout CW, Maron BJ, Vanderbrink BA, et al. Importance of the autonomic nervous system in an experimental model of commotio cordis. Med Sci Monit 2007; 13:BR11.
- Doerer JJ, Haas TS, Estes NA 3rd, et al. Evaluation of chest barriers for protection against sudden death due to commotio cordis. Am J Cardiol 2007; 99:857.
- Maron BJ, Haas TS, Ahluwalia A, et al. Increasing survival rate from commotio cordis. Heart Rhythm 2013; 10:219.
- Drezner JA, Rogers KJ, Zimmer RR, Sennett BJ. Use of automated external defibrillators at NCAA Division I universities. Med Sci Sports Exerc 2005; 37:1487.
- Wissenberg M, Lippert FK, Folke F, et al. Association of national initiatives to improve cardiac arrest management with rates of bystander intervention and patient survival after out-of-hospital cardiac arrest. JAMA 2013; 310:1377.
- NOCSAE finalizes first-ever football helmet standard to address concussion risks from rotational forces and first chest protector standard for commotio cordis. http://nocsae.org/wp-content/uploads/2017/02/NOCSAE-2017-January-Meeting-Release.pdf (Accessed on May 09, 2017).
- Weinstock J, Maron BJ, Song C, et al. Failure of commercially available chest wall protectors to prevent sudden cardiac death induced by chest wall blows in an experimental model of commotio cordis. Pediatrics 2006; 117:e656.
- Drewniak EI, Spenciner DB, Crisco JJ. Mechanical properties of chest protectors and the likelihood of ventricular fibrillation due to commotio cordis. J Appl Biomech 2007; 23:282.
- Alsheikh-Ali AA, Madias C, Supran S, Link MS. Marked variability in susceptibility to ventricular fibrillation in an experimental commotio cordis model. Circulation 2010; 122:2499.
- Maron BJ and Link MS. Recurrent commotio cordis: Deja vu. Heart Rhythm Case Reports 2015; 1:249.