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

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/hr (30 to 60 mph) to 128 swine ranging from 5 to 54 kg. Results VF occurred in 29% of impacts to the smallest animals compared to 34% in 14-23.9 kg group, 27% in 24-33.9 kg group, 30% in 34-43 kg group and 15% in the 44-54 kg animals. The highest weight group was associated with a significantly lower incidence of VF compared to other weights (p = 0.002). In a multivariate logistic regression analysis, controlling for repeated measures, 4 variables predicted VF: body weight (p=0.0008), velocity (p 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. Address for Correspondence: Mark S. Link, MD, UTSouthwestern Medical Center, 5939 Harry Hines BLVD, POB 1, Dallas, TX 75390, Email: mark.link@UTSouthwestern.edu Study supported by the National Operating Committee on Standards for Athletic Equipment (NOCSAE), Overland Park, KS. Mark S Link has research support from NOCSAE. No other author has any disclosures. The results of the present study do not constitute endorsement by ACSM. The results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. Accepted for Publication: 14 March 2018 © 2018 American College of Sports Medicine

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