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.


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

In This Article


CC is an increasingly reported cause of sudden cardiac death in young people, including athletes. Mechanism of sudden death appears to be induction of VF following a precordial chest wall blow occurring during a narrow window of vulnerability just before the peak of the T wave. This vulnerable window for VF induction exists owing to apparent intrinsic repolarization dispersion. Rapid LV pressure rise following chest impact likely results in myocardial stretch and the activation of ion channels, including the K+ ATP channel, via mechano-electric coupling. The generation of inward current through the mechano-sensitive ion channels likely results in augmentation of repolarization and nonuniform myocardial activation, and is the cause of premature ventricular depolarizations that are the triggers of VF. Overall survival is quite poor; however, successful resuscitation can be achieved with early defibrillation. Current commercially available chest protectors are ineffective in preventing VF due to their failure to substantially reduce the degree of LV pressure generated by chest wall impacts. The safety of young athletes will be enhanced by the development of more effective chest protectors and by more widespread access to AEDs at organized youth sporting events.

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