TY - JOUR
T1 - Reduced diameter spheres increases the risk of chest blowinduced ventricular fibrillation (commotio cordis)
AU - Kalin, John
AU - Madias, Christopher
AU - Alsheikh-Ali, Alawi A.
AU - Link, Mark S.
N1 - Funding Information:
This study was funded by the Louis J. Acompora Foundation and the North American National Operating Committee on Standards for Athletic Equipment. Mark S. Link has a patent on a chest protector that is designed to reduce the risk of sudden death with chest wall impact. This chest protector is licensed to Cascade Sports.
Copyright:
Copyright 2012 Elsevier B.V., All rights reserved.
PY - 2011/10
Y1 - 2011/10
N2 - Background: Sudden death due to low-energy blunt trauma to the precordium (commotio cordis) has been described with a variety of sporting objects. However, the risk of ventricular fibrillation (VF) relative to the shape of the impact object is not known. Objective: The objective of the current experiment is to test whether the impact object shape is a clinical variable that affects the risk for commotio cordis. Methods: In a juvenile swine model, impacts were given in random order with two different spherical shapes (72 mm diameter, equivalent to a baseball; 42 mm diameter, equivalent to a golf ball) and a flat round object 72 mm in diameter. Objects were equal in weight (150 g), thrown at 30 mph, and gated to the vulnerable portion of the cardiac cycle. Results: Sixteen swine received 144 impacts. The flat object did not cause VF (P =.01 compared with the two spherical objects), nonsustained VF, ST elevation, or bundle branch block. The smaller diameter sphere caused VF in nine of 48 impacts (19%), and the larger diameter sphere caused VF in five of 48 impacts (10%; P =.25). The smaller diameter sphere was associated with a greater increase in left ventricular pressure (P <.0001 and P =.001 compared with larger sphere only) and a higher likelihood of ST segment elevations (P <.001 and P =.08 compared with larger sphere only) and bundle branch block (Fisher's exact P =.008, and Fisher's exact P =.18 compared with larger sphere only). Conclusion: The shape of the projectile markedly influences the risk of VF from chest wall impact. This effect is likely mediated via a greater increase in left ventricular pressure with smaller diameter objects. Spreading the impact force over a larger area may decrease the risk of sudden death and has implications for the design of protective athletic equipment.
AB - Background: Sudden death due to low-energy blunt trauma to the precordium (commotio cordis) has been described with a variety of sporting objects. However, the risk of ventricular fibrillation (VF) relative to the shape of the impact object is not known. Objective: The objective of the current experiment is to test whether the impact object shape is a clinical variable that affects the risk for commotio cordis. Methods: In a juvenile swine model, impacts were given in random order with two different spherical shapes (72 mm diameter, equivalent to a baseball; 42 mm diameter, equivalent to a golf ball) and a flat round object 72 mm in diameter. Objects were equal in weight (150 g), thrown at 30 mph, and gated to the vulnerable portion of the cardiac cycle. Results: Sixteen swine received 144 impacts. The flat object did not cause VF (P =.01 compared with the two spherical objects), nonsustained VF, ST elevation, or bundle branch block. The smaller diameter sphere caused VF in nine of 48 impacts (19%), and the larger diameter sphere caused VF in five of 48 impacts (10%; P =.25). The smaller diameter sphere was associated with a greater increase in left ventricular pressure (P <.0001 and P =.001 compared with larger sphere only) and a higher likelihood of ST segment elevations (P <.001 and P =.08 compared with larger sphere only) and bundle branch block (Fisher's exact P =.008, and Fisher's exact P =.18 compared with larger sphere only). Conclusion: The shape of the projectile markedly influences the risk of VF from chest wall impact. This effect is likely mediated via a greater increase in left ventricular pressure with smaller diameter objects. Spreading the impact force over a larger area may decrease the risk of sudden death and has implications for the design of protective athletic equipment.
KW - Athletic injury
KW - Cardiac arrest
KW - Chest protectors
KW - Sudden cardiac death
KW - Ventricular fibrillation
UR - http://www.scopus.com/inward/record.url?scp=80053066883&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=80053066883&partnerID=8YFLogxK
U2 - 10.1016/j.hrthm.2011.05.009
DO - 10.1016/j.hrthm.2011.05.009
M3 - Article
C2 - 21699851
AN - SCOPUS:80053066883
SN - 1547-5271
VL - 8
SP - 1578
EP - 1581
JO - Heart Rhythm
JF - Heart Rhythm
IS - 10
ER -