Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 13: Commotio Cordis: A Scientific Statement From the American Heart Association and American College of Cardiology.

Abstract

Commotio cordis is defined as sudden cardiac death triggered by a relatively innocent blow to the precordium.1 Although initially thought to be extremely rare, it is now increasingly reported in the United States and worldwide.2,3 Enhanced recognition of commotio cordis, rather than an increase in event frequency, likely accounts for the greater visibility of those events. Commotio cordis is one of the most common causes of sudden cardiac death in recreational and competitive sports, instantaneously resulting in a potentially fatal arrhythmia.4 Commotio cordis is distinct from cardiac contusion, in which structural damage to the heart with resultant arrhythmias develops within 24 hours after severe chest impact.5 Risk factors for a commotio cordis have been defined by a Commotio Cordis Registry of clinical events and an experimental swine model. Human cases occur largely in adolescent males (95% of cases), with a mean age of 14 years.2 Impacts occur over the left chest wall and are generally sustained with a hard spherical object such as a baseball, hockey puck, lacrosse ball, or softball. Collapse is instantaneous or within a few seconds; when a defibrillator is used rapidly, the arrhythmia is typically ventricular fibrillation (VF). An experimental model of commotio cordis has confirmed the arrhythmia induced by a chest blow is VF.6 Impact must occur over the cardiac silhouette, and harder balls are more likely to induce VF.6–8 In addition, this model has demonstrated the critical importance of timing in that only those blows that occur during a narrow time segment of the T-wave upstroke reliably produce VF.6 These laboratory experiments have also shown the importance of size and shape of the object.9 Blows must occur directly perpendicular to the chest wall to produce VF, and impact velocities optimal to …