Size as an Important Determinant of Chest Blow-induced Commotio Cordis

• Published in: Medicine and science in sports and exercise Vol. 50; no. 9; p. 1767
• Main Authors: Madias, Christopher, Maron, Barry J, Dau, Nathan, Estes, 3rd, Nathan A Mark, Bir, Cynthia, Link, Mark S
• Format: Journal Article
• Language: English
• Published: United States 01.09.2018
• Subjects: Animals; Athletic Injuries - complications; Body Size; Commotio Cordis - etiology; Disease Models, Animal; Male; Swine; Thorax; Ventricular Fibrillation - etiology; Wounds, Nonpenetrating - complications
• ISSN: 1530-0315
• DOI: 10.1249/MSS.0000000000001630

Commotio cordis is sudden cardiac death caused by a relatively innocent blow to the left chest wall. Adolescents account for the majority of the cases; whether this is due to the higher frequency of adolescents playing ball sports or whether there is some maturational reduction of risk is not known. In a swine model of commotio cordis, the effect of body weight/size (directly related to age) to the susceptibility of chest impact-induced ventricular fibrillation (VF) is examined. Ball impacts were delivered at escalating velocities from 48.3 to 96.9 km·h (30-60 mph) to 128 swine ranging in weight from 5 to 54 kg. VF occurred in 29% of impacts to the smallest animals compared with 34% in the 14- to 239-kg group, 27% in the 24- to 33.9-kg group, 30% in 34- to 43-kg group, and 15% in the 44- to 54-kg animals. The highest-weight group was associated with a significantly lower incidence of VF compared with other weights (P = 0.002). In a multivariate logistic regression analysis, controlling for repeated measures, four variables predicted VF: body weight (P = 0.0008), velocity (P < 0.0001), distance from the center of the heart, (P < 0.0001), and peak left ventricular pressure induced by the blow (P = 0.0007). In this experimental model, animals weighing <44 kg seem to have a similar susceptibility to commotio cordis, whereas animals weighing ≥44 kg have a lower susceptibility. An increase in size of the individual, rather than reduced play of ball sports, is the likely reason for the decreased commotio cordis incidence in older individuals.