Size as an Important Determinant of Chest Blow-induced Commotio Cordis

Christopher Madias, Barry J. Maron, Nathan Dau, Nathan A.Mark Estes, Cynthia Bir, Mark S. Link

Research output: Contribution to journalArticlepeer-review


Purpose Commotio cordis is sudden cardiac death caused by a relatively innocent blow to the left chest wall. Adolescents account for the majority of the cases; whether this is due to the higher frequency of adolescents playing ball sports or whether there is some maturational reduction of risk is not known. Methods In a swine model of commotio cordis, the effect of body weight/size (directly related to age) to the susceptibility of chest impact-induced ventricular fibrillation (VF) is examined. Methods Ball impacts were delivered at escalating velocities from 48.3 to 96.9 km·h-1 (30-60 mph) to 128 swine ranging in weight from 5 to 54 kg. Results VF occurred in 29% of impacts to the smallest animals compared with 34% in the 14- to 239-kg group, 27% in the 24- to 33.9-kg group, 30% in 34- to 43-kg group, and 15% in the 44- to 54-kg animals. The highest-weight group was associated with a significantly lower incidence of VF compared with other weights (P = 0.002). In a multivariate logistic regression analysis, controlling for repeated measures, four variables predicted VF: body weight (P = 0.0008), velocity (P < 0.0001), distance from the center of the heart, (P < 0.0001), and peak left ventricular pressure induced by the blow (P = 0.0007). Conclusions In this experimental model, animals weighing <44 kg seem to have a similar susceptibility to commotio cordis, whereas animals weighing ≥44 kg have a lower susceptibility. An increase in size of the individual, rather than reduced play of ball sports, is the likely reason for the decreased commotio cordis incidence in older individuals.

Original languageEnglish (US)
Pages (from-to)1767-1771
Number of pages5
JournalMedicine and science in sports and exercise
Issue number9
StatePublished - Sep 1 2018



ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Physical Therapy, Sports Therapy and Rehabilitation


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