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Previous Volume 338:1805-1811 June 18, 1998 Number 25 Next

	Full Text PDF Editorial by Curfman, G. D. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background The syndrome of sudden death due to low-energy trauma to the chest wall (commotio cordis) has been described in young sports participants, but the mechanism is unknown.

Methods We developed a swine model of commotio cordis in which a low-energy impact to the chest wall was produced by a wooden object the size and weight of a regulation baseball. This projectile was thrust at a velocity of 30 miles (48 km) per hour and was timed to the cardiac cycle.

Results We first studied 18 young pigs, 6 subjected to multiple chest impacts and 12 to single impacts. Of the 10 impacts occurring within the window from 30 to 15 msec before the peak of the T wave on the electrocardiogram, 9 produced ventricular fibrillation. Ventricular fibrillation was not produced by impacts at any other time during the cardiac cycle. Of the 10 impacts sustained during the QRS complex, 4 resulted in transient complete heart block.

Conclusions This experimental model of commotio cordis closely resembles the clinical profile of this catastrophic event. Whether ventricular fibrillation occurred depended on the precise timing of the impact. Safety baseballs, as compared with regulation balls, may reduce the risk of commotio cordis.

Source Information

From the Cardiac Arrhythmia Service, Tufts–New England Medical Center, Boston (M.S.L., P.J.W., N.G.P., J.E.U., M.-Y.L., M.A.V., B.A.V., G.M., N.A.M.E.); the Maurice Lev Congenital Heart and Conduction Center, the Heart Institute for Children, Christ Hospital and Medical Center, Oak Lawn, Ill. (S.B.); and the Cardiovascular Research Division, Minneapolis Heart Institute Foundation, Minneapolis (B.J.M.).

Address reprint requests to Dr. Link at the New England Medical Center, Box 197, 750 Washington St., Boston, MA 02111.

Full Text of this Article

Related Letters:

Sudden Death Due to Low-Energy Chest-Wall Impact (Commotio Cordis)
Bökenkamp R., Paul T., Deady B., Haq C. L., Klein L., Link M. S., Maron B. J., Estes N.A. M., Curfman G. D.
Extract | Full Text  
N Engl J Med 1998; 339:1398-1399, Nov 5, 1998. Correspondence

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