Commotio Cordis -- Sudden Cardiac Death With Chest Wall Impact

Christopher Madias, M.D.; Barry J. Maron, M.D.; Jonathan Weinstock, M.D.; N. A. Mark Estes III, M.D.; Mark S. Link, M.D.

Disclosures

J Cardiovasc Electrophysiol. 2007;18(1):115-122. 

In This Article

History

Although it has achieved much more widespread recognition over the last 10 years, CC appears to have first been described as early as 1763, with subsequent accounts in the late 19th century.[4,9,13,14] Initial reports were confined to adults and focused on accidents that largely occurred in the workplace. In the 1870s, case reports of sudden death from such blows prompted the work of Felice Meola, an Italian physician, who experimented with chest impacts in rabbits.[15] Meola theorized that an extreme autonomic (vagal) reflex might account for the rare occurrence of sudden death observed in some of these rabbits.[4,13,14] In the 1930s, Georg Schlomka at Bonn University conducted extensive experiments in rabbits as well as cats and dogs. The anesthetized animals were subjected to chest wall blows with hammers while electrocardiograms and hemodynamic variables were monitored.[4,9,13,14,16] Schlomka was the first to describe a number of cardiac conduction abnormalities and arrhythmias as a result of chest wall blows, including bundle branch block, ST-segment changes, premature ventricular contractions, ventricular tachycardia, and VF. In addition, he invalidated the earlier autonomic reflex theory, as the above findings were reproducible in animals that had undergone sectioning of the vagus nerve. Schlomka identified three characteristics of the impact that were vital for the induction of cardiac arrhythmias: type, force, and location.[13,14] He suggested that a mechanically induced coronary vasospasm or "vascular crisis" might be responsible for the arrhythmias encountered in CC.

Over the subsequent 60 years (1935-1995), CC seems to have been largely forgotten and there was little mention of the phenomenon in the academic literature or news reports. In 1995, Maron et al. reported 25 cases of children and young adults, 3-19 years of age, who died as a result of blunt chest wall blow during competitive organized sport or other recreational settings.[2] Through the identification of these cases, a clinical profile of CC was developed that marked a shift in the focus of this phenomenon from an adult malady to one mostly seen in children and adolescents commonly involved in sporting activities.[4,17] Over the last 10 years, CC has achieved broader visibility through a series of reports offering comprehensive descriptions of its clinical spectrum coupled with significant insights into the underlying mechanisms provided by the advent of a contemporary, experimental model.[1,3,6,11,18,19,20,21,22,23,24]

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