The doctor is in

This is related to the question recently raised about centerline theory, which in turn led to discussion about striking targets on it. Dr. Rowe forwarded this about chest wall impact.

Volume 338:1805-1811 June 18, 1998 Number 25
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An Experimental Model of Sudden Death Due to Low-Energy Chest-Wall Impact
(Commotio Cordis)

Mark S. Link, M.D., Paul J. Wang, M.D., Natesa G. Pandian, M.D., Saroja
Bharati, M.D., James E. Udelson, M.D., Man-Young Lee, M.D., Mark A.
Vecchiotti, B.S., Brian A. VanderBrink, B.S., Gianluca Mirra, M.D., Barry J.
Maron, M.D., and N.A. Mark Estes, M.D.

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.