Commotio cordis

CommotioCordisTransparent

Commotio cordis is a rare phenomenon that can occur when chest wall trauma during the ascending limb of the T wave results in ventricular fibrillation and sudden cardiac death. The term commotio cordis translates to "agitation of the heart" in Latin.

Frequently, this occurs in young male athletes. The exact mechanism is unclear, however this is also the basis for using “synchronized cardioversion” during elective cardioversion of atrial fibrillation and atrial flutter. Synchronizing the shock with the QRS complex avoids delivering energy on the T wave, thus decreasing the risk of ventricular fibrillation.

Other causes of sudden cardiac death in young athletes include hypertrophic obstructive cardiomyopathy and coronary anomalies. Automated external defibrillators are readily available at most sporting events since early defibrillation is crucial to survival, which is only estimated at 35% in cases of commotio cordis.

References:

1. Maron BJ, Estes NAM, III. N Engl J Med. 2010; 362:917-927.

2. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, Tenth Edition, Saunders, Philadelphia, 2015.

3. Hurst's The Heart, Thirteenth Edition, McGraw-Hill, 2011.