Pathophysiology, Prevention, and Treatment of Commotio Cordis

Invasive Electrophysiology and Pacing (EK Heist, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Invasive Electrophysiology and Pacing


Commotio cordis is increasing described and it is now clear that this phenomenon is an important cause of sudden cardiac death on the playing field. Victims are predominantly young, male, and struck in the left chest with a ball. An animal model has been developed and utilized to explore the important variables and mechanism of commotio cordis. Impact during a narrow window of repolarization causes ventricular fibrillation. Other important variables include location, velocity, shape, and hardness of the impact object. Biological characteristics such as gender, pliability of the chest wall, and genetic susceptibility also play a role in commotio cordis. The mechanism of ventricular fibrillation appears to be an increase in heterogeneity of repolarization caused by induced abnormalities of ion channels activated by abrupt increases in left ventricular pressure. In the setting of altered repolarization a trigger of ventricular depolarization (premature ventricular depolarization caused directly by the chest blow) initiates a spiral wave that quickly breaks down into ventricular fibrillation. Prevention of commotio cordis is possible. Improved recognition and resuscitation have led to an improvement in outcome.


Commotio cordis Athlete Sudden cardiac death Ventricular fibrillation Sports 


Compliance with Ethics Guidelines

Conflict of Interest

Mark S. Link has a patent without any financial payment to him on chest wall protection.

Human and Animal Rights and Informed Consent

All animal research described was approved by the Institutional Animal Care and Use Committee of the Tufts Medical Center in conformity with the regulations of the Association for Assessment and Accreditation of Laboratory Animal Care.


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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.The Cardiac Arrhythmia CenterTufts Medical CenterBostonUSA
  2. 2.Tufts Medical CenterBostonUSA

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