Journal
MEDICINE AND SCIENCE IN SPORTS AND EXERCISE
Volume 50, Issue 9, Pages 1767-1771Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1249/MSS.0000000000001630
Keywords
COMMOTIO CORDIS; VENTRICULAR FIBRILLATION; ATHLETES; SUDDEN CARDIAC DEATH
Categories
Funding
- National Operating Committee on Standards for Athletic Equipment, Overland Park, KS
- National Operating Committee on Standards for Athletic Equipment
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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 kmh(-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.
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