Commotio Cordis at Athletes–Under Recognized Problem

Abstract

Commotio cordis (CC) is blunt, nonpenetrating trauma to the chest resulting in irregular heart rhythm and often leading to sudden death [1]. Commotio cordis is a primary arrhythmic event that occurs when the mechanical energy generated by a blow is confined to a small area of the precordium and profoundly alters the electrical stability of the myocardium, resulting in ventricular fibrillation [2]. It is most commonly associated with a sports-related injury, wherein, there is a high-velocity impact between a projectile and the precordium. By virtue of this impact, malignant arrhythmias consequently develop leading to the individual’s immediate demise, accompanied by a relatively normal post-mortem analysis [3]. The timing of the blow causes a CC is also important, which must occur during an electrically vulnerable period within a narrow window of 10 to 20msec on the upstroke of the T wave, just before its peak (accounting for only 1% of the cardiac cycle) [4]. Baseball, softball, hockey and football a four most often sport activities competitive as well recreational in which CC appears [4]. According to Marijon only 2% of sudden cardiac death (SCD) in sport is caused in mechanism of commotio cordic [5,6].