TY - JOUR
T1 - Size as an Important Determinant of Chest Blow-induced Commotio Cordis
AU - Madias, Christopher
AU - Maron, Barry J.
AU - Dau, Nathan
AU - Estes, Nathan A.Mark
AU - Bir, Cynthia
AU - Link, Mark S.
N1 - Publisher Copyright:
Copyright © 2018 by the American College of Sports Medicine.
PY - 2018/9/1
Y1 - 2018/9/1
N2 - 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.
AB - 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.
KW - ATHLETES
KW - COMMOTIO CORDIS
KW - SUDDEN CARDIAC DEATH
KW - VENTRICULAR FIBRILLATION
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U2 - 10.1249/MSS.0000000000001630
DO - 10.1249/MSS.0000000000001630
M3 - Article
C2 - 29620687
AN - SCOPUS:85051588351
SN - 0195-9131
VL - 50
SP - 1767
EP - 1771
JO - Medicine and science in sports and exercise
JF - Medicine and science in sports and exercise
IS - 9
ER -